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Methotrexate and doxycycline interaction: a rare cause of pancytopenia
  1. Ahmad Arslan1,
  2. Muhammad Abdullah Zain2,
  3. Maryam Mukhtar3,
  4. Waqas Ullah1 and
  5. Sohaib Roomi1
  1. 1 Abington Hospital - Jefferson Health, Abington, Pennsylvania, USA
  2. 2 Sheikh Zayed Medical College, Rahim Yar Khan, Pakistan
  3. 3 Fauji Foundation Hospital, Rawalpindi, Pakistan
  1. Correspondence to Dr Waqas Ullah, waqasullah.dr{at}


Methotrexate (MTX) was originally formulated as one of the first antitumour drugs due to its ability to alter folate metabolism, which renders it to be an antiproliferative agent. Classically, the higher dosage is administered via parenteral route, in a cyclical fashion, to achieve antitumour effects. Patients on high doses of MTX are prone to develop rare complications of myelosuppression and pancytopenia, in a dose-dependent fashion, secondary to altered folate metabolism.1 Herein, we present a unique case of rheumatoid arthritis presented with pancytopenia due to low-dose MTX and doxycycline drug interaction. We also report the successful management of pancytopenia and oral ulcers with combination therapy of leucovorin and granulocyte colony-stimulating factor.

  • drugs and medicines
  • contraindications and precautions

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  • Contributors AA managed the case and drafted the case presentation. MAZ did the abstract and discussion. MM worked on references and literature search. WU did the critical review and revision. SR worked on reviewer’s concerns and reviewed the case.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent for publication Obtained.