Severe Pancytopenia Induced by Methotrexate in a Rheumatoid Arthritis Patient

Authors : Müge Özgüler, Alper Koç, Hakan Ayyıldız

Pages : 44-47

Doi:10.33706/jemcr.1634492

View : 15 | Download : 12

Publication Date : 2025-03-28

Article Type : Other Papers

Abstract :Rheumatoid arthritis (RA) is a systemic autoimmune disease affecting approximately 1% of the global population, with a higher prevalence in women. Methotrexate (MTX), a disease-modifying antirheumatic drug (DMARD), is commonly used in RA treatment. However, improper or unsupervised use can lead to severe hematological toxicities, including pancytopenia. A 74-year-old female patient with RA presented with fever, oral ulcers, weakness, and difficulty swallowing. Physical examination revealed ecchymotic skin lesions and candidal plaques in the oral cavity. Laboratory results indicated severe pancytopenia (WBC: 1.1 × 10⁹/L, RBC: 2.75 x 1012/L, PLT: 9 × 10⁹/L). Methotrexate intoxication was suspected. The patient received supportive treatment, including folate supplementation, Filgrastim for neutropenia, platelet apheresis, and erythrocyte transfusion. Scattergram analysis revealed marked alterations in neutrophil and eosinophil populations. Following treatment, hematological parameters normalized, but neutrophil volume changes persisted, suggesting a prolonged bone marrow effect of MTX. This case highlights the importance of routine complete blood count monitoring, including scattergram analysis, in RA patients receiving DMARD therapy. Laboratories should consider adjusting CBC measurement protocols in cases of suspected drug-induced pancytopenia to enhance diagnostic accuracy and early detection of hematological toxicity.
Keywords : Metotreksat toksisitesi, pansitopeni, romatoid artrit