Death due to severe myelosuppression and sepsis caused by methotrexate in patients with ectopic pregnancy

A 22-year-old woman was given mifepristone tablets (150 mg, once daily) orally for 4 days and intramuscular injection of methotrexate (MTX) 75 mg once on day 4 for ectopic pregnancy. About 5 hours after injection, the patient developed nausea and vomiting. The next day, the rash appeared and scattered on the head and face with pain and itching. Loratadine tablets 10 mg once daily were given orally, but the rash gradually aggravated. On day 5 after MTX treatment, pustules appeared on the back and chest, and oral mucosal ulceration occurred. On day 6, the patient developed persistent high fever, with white blood cell count 0.28×109/L, neutrophil count 0.07×109/L, platelet count 16×109/L, and hemoglobin 36 g/L. On day 8, the patient developed skin and mucosa swelling, accompanied by ulcer, epistaxis and superficial lymph node tumefaction. The patient was diagnosed with severe myelosuppression and sepsis, which was caused by methotrexate. Symptomatic and supportive treatments such as anti-allergy, anti-infection, leukocyte proliferation, antipyretic, and intravenous gamma globulin were given. Due to the limited hospital condition, without salvage therapy with calcium folinate was given. The patient′s condition became worse and she eventually died of multiple organ failure on day 17 after MTX treatment. Key words: Methotrexate; Pregnancy, ectopic; Pancytopenia; Sepsis; Death