Hemophagocytic Syndrome Caused by Methotrexate Overdose in a Total Knee Arthroplasty Patient: A Case Report

Chen Liu; Ning Liu; Junfeng Wang; Xinguang Liu; Ke Zhang; Feng Li

doi:10.2106/JBJS.CC.20.00068

Hemophagocytic Syndrome Caused by Methotrexate Overdose in a Total Knee Arthroplasty Patient: A Case Report

JBJS Case Connect. 2020 Sep 25;10(3):e20.00068. doi: 10.2106/JBJS.CC.20.00068. eCollection 2020 Jul 1.

Authors

Chen Liu¹, Ning Liu², Junfeng Wang¹, Xinguang Liu¹, Ke Zhang³, Feng Li³

Affiliations

¹ Department of Orthopaedics, Peking University International Hospital, Beijing, China.
² Department of Orthopaedic Surgery, Stanford University, Redwood City, California.
³ Department of Orthopaedics, Peking University Third Hospital, Beijing, China.

PMID: 37475453
DOI: 10.2106/JBJS.CC.20.00068

Abstract

Case: We report a patient with rheumatoid arthritis (RA) who developed hemophagocytic syndrome (HPS). The HPS was attributed to sepsis, itself a consequence of methotrexate (MTX) overdose. The discovery of MTX overdose was facilitated by the presence of epidermolysis bullosa, multiple ulcers of the whole digestive tract, and additional history from the patient's family.

Conclusion: For arthroplasty patients with underlying inflammatory disorders such as RA, drug history should be thoroughly inquired. Correct diagnosis results from careful history review, detailed physical examination, and necessary laboratory tests.