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영남의대학술지 Vol.28 No.1 p60-69, June2011
Case Report
류마티스 관절염을 가진 만성신질환 환자에서 저용량 methotrexate 투여 후 발생한 중증 범혈구 감소증 2예
Two Cases of Severe Pancytopenia Associated with Low-Dose Methotrexate Therapy in Patients with Chronic Kidney Disease and Rheumatoid Arthritis
김홍익, 이우현, 오장석, 홍효림, 이인희
대구가톨릭대학교 의과대학 내과학교실
교신저자：이인희, 대구광역시 남구 대명4동 3056-6, 대구가톨릭대학교 의과대학 내과학교실
Tel: (053) 650-4216, Fax: (053) 650-4570
E-mail : ihlee@cu.ac.kr
June 30, 2011
Abstract
Due to its efficacy and tolerability, low dose oral methotrexate(MTX) therapy has been widely used for treatment of rheumatoid arthritis(RA). However, it can rarely cause serious, life-threatening hematologic toxicities, such as pancytopenia. We report here on two patients with chronic kidney disease(CKD), who developed severe pancytopenia after 5 years (cumulative dose 1,240mg) and 4 years(cumulative dose 1,320mg) of low dose MTX therapy for treatment of RA, respectively. Both patients presented with renal insufficiency, hypoalbuminemia, concurrent use of nonsteroidal anti-inflammatory drugs, and elevated mean corpuscular volume of red blood cells(RBCs), all of which are known as risk factors of MTX-induced pancytopenia. Despite receiving treatment, which included RBC and platelet transfusions, antibiotic therapy, granulocyte colony stimulating factor, and leucovorin rescue, one patient died of sepsis. Based on our case study, prompt investigation of risk factors associated with MTX toxicity is required for all patients receiving MTX therapy. MTX treatment, even at a low dose, should be discontinued in patients with advanced CKD.
Key Words: Pancytopenia, Methotrexate, Chronic kidney disease, Rheumatoid arthritis
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