Article Text

PDF
CASE REPORT
Severe bone marrow suppression due to methotrexate toxicity following aceclofenac-induced acute kidney injury
  1. Robin George Manappallil1,
  2. Durga Prasan2,
  3. Jayameena Peringat3,
  4. Illolil Kuniyil Biju4
  1. 1Internal Medicine, Baby Memorial Hospital, Calicut, Kerala, India
  2. 2Medical Oncology, Baby Memorial Hospital, Calicut, Kerala, India
  3. 3Nephrology, Baby Memorial Hospital, Calicut, Kerala, India
  4. 4Medical Gastroenterology, Baby Memorial Hospital, Calicut, Kerala, India
  1. Correspondence to Dr Robin George Manappallil, drrobingeorgempl{at}gmail.com

Summary

Methotrexate is one of the most commonly used drugs in autoimmune disorders like rheumatoid arthritis. Gastrointestinal symptoms like nausea and stomatitis, skin rashes, alopecia, central nervous system symptoms like headache and confusion, hepatotoxicity and myelosuppression are some of the adverse effects. However, low oral doses on a weekly basis seldom show any signs of toxicity. Leucovorin or folinic acid is given along with methotrexate as rescue to reduce the toxic effects like bone marrow suppression. Non-steroidal anti-inflammatory drugs, like aceclofenac, are also used in chronic inflammatory conditions like rheumatoid arthritis and osteoarthritis. Nephrotoxicity is one of the adverse effects of both methotrexate and non-steroidal anti-inflammatory drugs; and its combined administration should be done with caution. This is a case of an elderly woman, a known case of rheumatoid arthritis, who presented in severe bone marrow suppression due to methotrexate toxicity following aceclofenac-induced acute kidney injury.

  • acute renal failure
  • rheumatoid arthritis

Statistics from Altmetric.com

Footnotes

  • Contributors RGM: concept and design of case report, reviewed the literature, manuscript preparation and treating physician. DP: reviewed the literature and treating medical oncologist. JP: reviewed the literature and treating nephrologist. IKB: reviewed the literature and treating gastroenterologist.

  • 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.

  • Patient consent Parental/guardian consent obtained.

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

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.