Abstract
This case report describes the successful treatment of severe methotrexate intoxication in a 72-year-old female patient. Following two prior uneventful courses of a polychemotherapy regimen including low-dose intravenous (i.v.) methotrexate, the patient presented with fever, polymucositis, incipient pyodermia, acute renal failure and pancytopenia 9 days after the third application. Severe methotrexate overdose was confirmed by serum levels. Using a polypragmatic treatment approach focusing on renal function and including granulocyte-macrophage-colony-stimulating factor (GM-CSF) this life threatening and nearly fatal intoxication was successfully treated. This case report demonstrates that GM-CSF might contribute to rapid reconstitution of leukopoiesis once methotrexate serum levels are in the subtoxic range.
MeSH terms
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Acute Disease
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Aged
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Antineoplastic Combined Chemotherapy Protocols / adverse effects
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Antineoplastic Combined Chemotherapy Protocols / therapeutic use
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Chemotherapy, Adjuvant / adverse effects
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Combined Modality Therapy
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Cyclophosphamide / administration & dosage
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Cyclophosphamide / adverse effects
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Drug Overdose / etiology
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Drug Overdose / therapy
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Female
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Fluorouracil / administration & dosage
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Fluorouracil / adverse effects
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Granulocyte-Macrophage Colony-Stimulating Factor / administration & dosage*
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Humans
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Methotrexate / administration & dosage
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Methotrexate / adverse effects
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Methotrexate / poisoning*
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Postoperative Care / adverse effects
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Recombinant Proteins / administration & dosage
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Time Factors
Substances
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Recombinant Proteins
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Granulocyte-Macrophage Colony-Stimulating Factor
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Cyclophosphamide
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Fluorouracil
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Methotrexate