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KMID : 1149120230200010039
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Journal of the Korean Society for Psoriasis
2023 Volume.20 No. 1 p.39 ~ p.43
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Low-Dose Methotrexate Toxicity in Psoriasis Vulgaris Patient with End-Stage Renal Disease undergoing Hemodialysis
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Moon Su-Jin
Jang Yun-Kyung
Kim Dong-Hyun
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Abstract
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Methotrexate is an effective treatment for psoriasis and psoriatic arthritis. However, as methotrexate is mainly eliminated by the kidneys, patients with chronic kidney disease may experience hematologic complications such as myelosuppression due to methotrexate toxicity. A 58-year-old male psoriasis patient with end-stage renal disease undergoing hemodialysis was treated with low-dose MTX (7.5 mg/week) and developed pancytopenia after 5 weeks of treatment. His serum MTX level was < 0.040 umol/L. While MTX toxicity typically occurs within 7~14 days, in this case, it occurred one month later. Despite the low levels of MTX in his blood, myelosuppression led to pancytopenia, which resulted in the development of pneumonia with Pseudomonas aeruginosa infection. Ultimately, this led to septic shock and the patient’s death. In conclusion, since low-dose MTX toxicity in CKD patients is challenging to predict, we should exercise extra caution.
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KEYWORD
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End-stage renal disease, Methotrexate, Myelosuppression, Psoriasis
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