Death attributed to severe myelosuppression due to methotrexate

A 30-year-old woman was hospitalized because of ectopic pregnancy. She received an intramuscular injection of methotrexate 75 mg and mifepristone tablets 300 mg taking orally in three days. On day 5, the patient developed fever and oral ulcers. On day 7, red rashes appeared on her face and limbs. Laboratory tests showed the following results: C-reactive protein (CRP) 105.3 mg /L, procalcitonin 0.33 μg/L, white blood cell (WBC) 2.5×109/L, neutrophil count 0.85, red blood cell (RBC) 3.3×1012/L, platelet count (PLT) 244×109/L, hemoglobin (Hb)103 g/L. On the 8th day, abdominal pain and diarrhea appeared, her values of WBC, neutrophils, RBC, PLT, and Hb were 0.7×109/L, 0.31, 3.4×1012/L, 202×109/L, 105 g/L. She was diagnosed as myelosuppression due to methotrexate. She received an IV infusion of methylprednisolone 80 mg once daily, subcutaneous injection of recombinant human granulocyte colony stimulating factor 300 μg, and the symptomatic supportive treatments included anti-infection, volume expansion, and intravenous nutrition. However, the patient′s condition did not improve obviously. On day 10, the erythema widely distributed throughout her body. Laboratory tests showed WBC 0.2×109/L, neutrophil count 0.14, RBC 2.7×1012/L, PLT 62×109/L, Hb 84 g/L. On day 11, the patient was transferred to another hospital for treatment. It was told by follow-up that the patient died from respiratory and circulatory failure on the third day after transfer. Key words: Methotrexate; Myelosuppression