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

Methotrexate在長期血液透析的乾癬病人引起全血細胞低下症一病例報告

林易生(Yi-Sheng Lin) ； 吳岳霖(Yueh-Lin Wu) ； 陳麗琴(Li-Chin Chen) ； 羅文景(Wen-Ching Lo) ； 葉啟昌(Chii-Chang Yeh) ； 高木榮(Mu-Jung Kao)

《北市醫學雜誌》 13卷3期 (2016/09) Pp. 168-175

https://doi.org/10.6200/TCMJ.2016.13.3.17

摘要

目的：氨甲喋呤常被用來治療乾癬。慢性腎臟病病人使用氨甲喋呤會顯著增加其毒性，特別是骨髓毒性。對於在已接受血液透析的乾癬患者是否可以給予氨甲喋呤治療在過往的文獻中很少報告。病例報告：一位69歲接受長期血液透析的男性乾癬患者接受氨甲喋呤每週7.5 毫克治療。兩週後病人產生全血細胞低下症，口炎，肝炎，皮疹等嚴重併發症。病患在停用氨甲喋呤治療後，接受廣效抗生素、亞葉酸鈣、白血球生長激素和輸血治療，並增加血液透析頻次後成功康復。結論：在血液透析患者使用氨甲喋呤治療乾癬應十分謹慎，即使是低劑量亦可導致致死性全血細胞低下症。在面對併發症時，高度警覺心和充分的支持性療法，可以降低併發症及死亡。

關鍵字

氨甲喋呤 ； 乾癬 ； 血液透析 ； 全血細胞低下症

並列摘要

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.

並列關鍵字

methotrexate ； psoriasis ； hemodialysis ； pancytopenia