Low-dose methotrexate-induced pancytopenia in three patients with impaired renal function

Sun Hee Ko,; Seung Min Jung,; Ah Young Shin,; Mine Ok Chang,; Jin Seok Kim,; Han Hee Lee,; Chul Woo Yang,

Korean J Med > Volume 77(5); 2009 > Article

Original Article

The Korean Journal of Medicine 2009;77(5):637-642.

Low-dose methotrexate-induced pancytopenia in three patients with impaired renal function

Sun Hee Ko, Seung Min Jung, Ah Young Shin, Mine Ok Chang, Jin Seok Kim, Han Hee Lee, Chul Woo Yang

신기능이 저하된 환자에서 저용량 메토트렉세이트에 의한 범혈구감소증

고선희, 정승민, 신아영, 장민옥, 김진석, 이한희, 양철우

Abstract

Methotrexate (MTX) is indicated for patients with moderate to severe rheumatoid arthritis (RA), but it sometimes causes severe hematologic complications in patients with impaired renal function. We experienced three cases of pancytopenia due to low-dose MTX treatment in RA patients with impaired renal function. Two patients were dialysis patients, and the other had stage 4 chronic kidney disease. The mean cumulative MTX dose and treatment duration for the three patients was 25 mg and 10 days, respectively. All cases experienced severe stomatitis and pancytopenia and recovered with conservative care. In conclusion, MTX should be used cautiously in patients with impaired renal function.

Key Words: Methotrexate; Impaired renal function; Pancytopenia