Nephrotoxicity Associated with Low-dose Methotrexate and Outpatient Parenteral Microbial Therapy: A Case Report, Review of the Literature and Pathophysiologic Insights
| Autor: | Gil Hevroni, Cameron Page, Benjamin Ramalanjaona, Moro O. Salifu, Samantha Cham, Samy I. McFarlane |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2020 |
| Předmět: |
medicine.medical_specialty
outpatient parenteral antimicrobial therapy Neutropenia Gastroenterology Article anti-folate methotrexate Nephrotoxicity 03 medical and health sciences 0302 clinical medicine Internal medicine Mucositis Medicine 030212 general & internal medicine Adverse effect General Environmental Science 030203 arthritis & rheumatology business.industry nephrotoxicity Acute kidney injury medicine.disease monitoring Rheumatoid arthritis surveillance General Earth and Planetary Sciences Vancomycin Methotrexate business medicine.drug |
| Zdroj: | American journal of medical case reports |
| ISSN: | 2374-216X 2374-2151 |
| Popis: | Methotrexate (MTX) toxicity can affect multiple organ systems, manifesting as nephrotoxicity, myelosuppression, hepatotoxicity, mucositis, and gastrointestinal upset. Serious adverse events are rare in patients prescribed low-dose methotrexate. We present a case of an 86-year-old female on a weekly dose of oral MTX 12.5 mg for rheumatoid arthritis presenting with painful gingiva and oral bleeding during outpatient antimicrobial therapy (OPAT) for osteomyelitis with vancomycin and piperacillin-tazobactam. She had acute kidney injury (AKI), elevated serum MTX levels, thrombocytopenia, neutropenia, and a vancomycin level three times therapeutic concentration. MTX toxicity was suspected to have been triggered by vancomycin and piperacillin-tazobactam causing AKI and impaired renal clearance of MTX which itself is nephrotoxic. The patient was managed with leucovorin, alkalinized intravenous fluids, and filgrastim injections over a 2-week period. Her renal function continued to be reduced at 5-week outpatient follow-up, far after other markers of toxicity normalized. This case demonstrates the importance of considering potential drug-drug interactions and the need for robust monitoring for OPAT in select groups. |
| Databáze: | OpenAIRE |
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