Methotrexate-Induced Pancytopenia in a Psoriatic Patient under Chronic Hemodialysis: A Case Report

Abstract

Objectives: Methotrexate (MTX) is one of the most prescribed disease-modifying anti-rheumatic drugs for psoriasis patients. Several studies have reported on the increased toxicity, especially bone marrow toxicity, of MTX in patients of chronic kidney disease or dialysis. Whether MTX could be administered to psoriatic patients on chronic hemodialysis has rarely been addressed in the literature. Case Report: We reported a 69 year-old psoriatic male patient on chronic hemodialysis for 14 months received MTX 7.5 mg per week. After two weeks of MTX, several complications occurred including pancytopenia, stomatitis, hepatitis, and skin rash. The patient was treated successfully with broad-spectrum antibiotics, leucovorin, granulocyte colony-stimulating factor, blood transfusions and intensified hemodialysis. Conclusion: Physicians should be very cautious on the use of MTX in psoriatic patients under hemodialysis, as even low-dose MTX can lead to lethal pancytopenia with opportunistic infection early in the course of treatment. High index of suspicion and adequate supportive treatment are the way to prevent the lethal complications.