Volume 12, Issue 4 (2026)
Pharm Biomed Res 2026, 12(4): 0-0 |
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Shadfar F, Shadfar L. Severe Pancytopenia and Multisystem Toxicity Following Single-Dose Methotrexate for Ectopic Pregnancy: A Case Report. Pharm Biomed Res 2026; 12 (4)
URL: http://pbr.mazums.ac.ir/article-1-743-en.html
URL: http://pbr.mazums.ac.ir/article-1-743-en.html
1- Assistant Professor of Clinical Pharmacy, Faculty of Pharmacy, Urmia University of Medical Science, Iran.
2- Imam Khomeini Hospital, Urmia University of Medical Sciences, Urmia, Iran.
2- Imam Khomeini Hospital, Urmia University of Medical Sciences, Urmia, Iran.
Abstract: (4 Views)
Methotrexate (MTX), a folate antagonist, is widely used for the medical management of ectopic pregnancy (EP) and is generally considered safe when administered as a single low-dose regimen (50 mg/m²). Severe toxicity is rare and typically associated with high-dose or prolonged therapy. We report a case of life-threatening pancytopenia and multisystem toxicity following a single intramuscular 90 mg dose of MTX in a 32-year-old woman with no prior medical history treated for left tubal EP.
Four days after MTX administration, the patient developed gastrointestinal symptoms. By Day 11, she presented with severe pancytopenia, mucositis, petechiae, purpura, hepatic dysfunction, and pleural effusion. She required intensive care unit admission and comprehensive management, including intravenous leucovorin rescue, granulocyte colony-stimulating factor (filgrastim), broad-spectrum antibiotics, antifungal therapy, platelet and packed red blood cell transfusions, urinary alkalinization, and supportive care. Hematologic parameters gradually recovered, with white blood cell count rising from a nadir of 900/µL to 68,300/µL by Day 19, and liver function improved progressively. She was discharged in stable condition.
This case underscores that severe MTX toxicity may occur even after a standard single low dose in patients without recognized risk factors. Pharmacogenetic variability—particularly polymorphisms in genes involved in folate metabolism and drug transport—may contribute to heightened susceptibility. Careful clinical and laboratory monitoring, early recognition of atypical symptoms, and prompt initiation of rescue therapy are essential to prevent fatal outcomes.
Four days after MTX administration, the patient developed gastrointestinal symptoms. By Day 11, she presented with severe pancytopenia, mucositis, petechiae, purpura, hepatic dysfunction, and pleural effusion. She required intensive care unit admission and comprehensive management, including intravenous leucovorin rescue, granulocyte colony-stimulating factor (filgrastim), broad-spectrum antibiotics, antifungal therapy, platelet and packed red blood cell transfusions, urinary alkalinization, and supportive care. Hematologic parameters gradually recovered, with white blood cell count rising from a nadir of 900/µL to 68,300/µL by Day 19, and liver function improved progressively. She was discharged in stable condition.
This case underscores that severe MTX toxicity may occur even after a standard single low dose in patients without recognized risk factors. Pharmacogenetic variability—particularly polymorphisms in genes involved in folate metabolism and drug transport—may contribute to heightened susceptibility. Careful clinical and laboratory monitoring, early recognition of atypical symptoms, and prompt initiation of rescue therapy are essential to prevent fatal outcomes.
Keywords: Methotrexate, Ectopic Pregnancy, Pancytopenia, Multisystem toxicity, Genetic susceptibility, Pharmacogenetic
Type of Study: case report |
Subject:
Clinical Pharmacy
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