Abstract
A 30-years-old female presented to emergency department with a history of fever, epistaxis and bleeding gums since 3 days. She gave history of methotrexate (MTX) prescribed for joint pain (a cumulative dose of 20 mg in 3 days) prior to the presentation. Her blood counts were normal prior to MTX ingestion. But on the day of admission, all the three cell lines were low. She was given 5 units of fresh whole blood and antimicrobial and antifungal coverage during her total stay in the hospital. Her bone marrow finding was suggestive of aplastic anemia/drug induced bone marrow suppression. After 2 weeks of supportive therapy, her blood counts were normal. She was advised to repeat bone marrow examination, which she denied. Her anti-CCP levels were normal and did not meet the criteria for rheumatoid arthritis so advised to stop MTX. Although, pancytopenia associated with low-dose MTX therapy is not expected as early as 3 days after initiation of the therapy, physicians should also be aware of this life threatening adverse effect during the very first days of MTX therapy.
Published Version
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