Methotrexate (MTX) is first line drug used in the management of rheumatoid arthritis. Side effects of MTX high dose (MTX-HD) can be life threatening. MTX mainly affects bone marrow, gastrointestinal mucosa and hair. This is the case report of a rheumatoid arthritis patient treated with methotrexate (7.5 gm), methyl prednisolone (500 mg), sulfasalazine (8 mg). Patient has taken 4 tablets of methotrexate (7.5 mg) for 4 days continuously instead of taking once a week as prescribed. Patient also did not take folic acid as prescribed to him. After 10 days he was hospitalized with severe leukocytopenia associated with fever, loose stools, dysphagia, abdominal pain at GSL General Hospital, Rajahmundry. He further developed right lung pneumonia, toxic epidermal necrolysis (TEN), oral candidiasis, GI side effects due to immunosuppression caused by methotrexate. He was treated with intravenous antibiotic therapy, corticosteroids, Filgrastim injection, IV potassium supplements. The MTX toxicities are based on the duration and cumulative dosing of drug and its use in combination with other drugs. Myelosuppression and consequent pancytopenia are the most frequent hematologic toxicity, which occur mostly later during low dose methotrexate administration. He was treated with intravenous antibiotic therapy, corticosteroids, Inj. Filgrastim, IV Potassium supplements and limited transfusion dependence as a result of renal failure caused due to low dose methotrexate.
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