Severe toxic effects of low‐dose methotrexate treatment for placenta accreta in a patient with methylenetetrahydrofolate reductase mutations

2019 ◽  
Vol 45 (1) ◽  
pp. 214-217 ◽  
Author(s):  
Zhiyuan Tan ◽  
Wei Liu ◽  
Hua Guo ◽  
Kai Hu ◽  
Rongsheng Zhao
Keyword(s):  
Low Dose ◽  
Methylenetetrahydrofolate Reductase ◽  
Placenta Accreta ◽  
Toxic Effects ◽  
Dose Methotrexate ◽  
Methotrexate Treatment

scholarly journals Severe Adverse Toxic Effects of Low-Dose Methotrexate Treatment on an Ectopic Pregnancy Patient With Methylenetetrahydrofolate Reductase Mutations: A Case Report

2021 ◽  
Vol 8 ◽  
Author(s):  
Huan Yu ◽  
Wenhui Wang ◽  
Haiyan Liang ◽  
Kun Wang ◽  
Bin Ling
Keyword(s):  
Ectopic Pregnancy ◽  
Low Dose ◽  
Methylenetetrahydrofolate Reductase ◽  
Rare Condition ◽  
Skin Lesions ◽  
Toxic Effects ◽  
Literature Report ◽  
Case Presentation ◽  
Dose Methotrexate ◽  
Life Threatening

Background: Low-dose methylenetetrahydrofolate (LD-MTX) has been widely used for the treatment of the ectopic pregnancy (EP) for many decades, and related severe adverse toxic effects are rare. Current studies have shown that the polymorphisms of methylenetetrahydrofolate reductase (MTHFR) gene can decrease the MTX clearance, leading to the metabolite accumulation. However, there is a lack of literature report on an MTHFR gene polymorphism associated with adverse toxic effects resulting from the use of LD-MTX in an EP.Case Presentation: We report a rare case of a 38-year-old female who developed persistent fever, grade IV myelosuppression, skin lesions, mucositis, and liver injury after single dose of LDMTX to treat EP. The personalized genetic testing showed that MTHFR TT (677C>T) and MTHFR AA (1298A>C) were detected. Gradually, the symptoms improved after calcium leucovorin (CF) rescue, continuous renal replacement therapy (CRRT), promoting blood system regeneration, and multiple supportive treatments.Conclusion: This is the first report on the serious adverse toxic effects of LD-MTX on an EP patient with MTHFR mutations. We aim to alert obstetricians and gynecologists to this rare condition. The unexpected life-threatening toxicity with LD-MTX should be highly considered and recognized early. In particular, some easily overlooked gastrointestinal, skin, and mucosal symptoms occur earlier than severe myelosuppression. When toxic effects are suspected, detecting the polymorphisms of an MTHFR gene and monitoring MTX concentration in blood could assist us to formulate individualized and active treatments.

scholarly journals Pulsed High-Dose Corticosteroids Combined With Low-Dose Methotrexate Treatment in Patients With Refractory Generalized Extragenital Lichen Sclerosus

2009 ◽  
Vol 145 (11) ◽  
Author(s):  
Alexander Kreuter ◽  
Christian Tigges ◽  
Renata Gaifullina ◽  
Julia Kirschke ◽  
Peter Altmeyer ◽  
...  
Keyword(s):  
Low Dose ◽  
Lichen Sclerosus ◽  
High Dose ◽  
Dose Methotrexate ◽  
Methotrexate Treatment

EFFICACY OF LOW-DOSE METHOTREXATE TREATMENT IN BIRDSHOT CHORIORETINOPATHY

Retina ◽  
2011 ◽  
Vol 31 (6) ◽  
pp. 1150-1155 ◽  
Author(s):  
Aniki Rothova ◽  
Annette Ossewaarde-van Norel ◽  
Leonoor I Los ◽  
Tos T J M Berendschot
Keyword(s):  
Low Dose ◽  
Birdshot Chorioretinopathy ◽  
Dose Methotrexate ◽  
Methotrexate Treatment

Oral effects of low-dose methotrexate treatment

2005 ◽  
Vol 100 (1) ◽  
pp. 52-62 ◽  
Author(s):  
Athanasios Kalantzis ◽  
Zoe Marshman ◽  
Denis T. Falconer ◽  
Peter R. Morgan ◽  
Edward W. Odell
Keyword(s):  
Low Dose ◽  
Dose Methotrexate ◽  
Methotrexate Treatment

Low-dose methotrexate treatment in ectopic pregnancy: a retrospective analysis of 164 ectopic pregnancies treated between 2000 and 2008

2013 ◽  
Vol 289 (2) ◽  
pp. 329-335 ◽  
Author(s):  
Johannes Lermann ◽  
Petra Segl ◽  
Sebastian M. Jud ◽  
Matthias W. Beckmann ◽  
Peter Oppelt ◽  
...  
Keyword(s):  
Ectopic Pregnancy ◽  
Retrospective Analysis ◽  
Low Dose ◽  
Dose Methotrexate ◽  
Methotrexate Treatment ◽  
Ectopic Pregnancies
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