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| IMAGE IN HEMATOLOGY |
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| Year : 2023 | Volume
: 14
| Issue : 1 | Page : 67 |
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Methotrexate-Related pancytopenia associated with induced dysplasia
Nicolas Athanase, Elise Frebet
Laboratory of Hematology, Agen-Nerac Hospital, Agen, France
| Date of Submission | 14-Oct-2022 |
| Date of Acceptance | 30-Nov-2022 |
| Date of Web Publication | 17-Feb-2023 |
Correspondence Address:
Dr. Nicolas Athanase
Laboratoire de Biologie Médicale, Centre Hospitalier Agen-Nérac, Route de Villeneuve Sur Lot, Saint-Esprit 47923 Agen
France
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/joah.joah_92_22
How to cite this article:
Athanase N, Frebet E. Methotrexate-Related pancytopenia associated with induced dysplasia. J Appl Hematol 2023;14:67 |
A 63-year-old woman presented with persistent oral pain and trismus. The patient suffered from obesity, diabetes, and rhizomelic pseudo-polyarthritis treated with corticosteroids and weekly low dose of methotrexate (MTX). Laboratory results revealed a severe pancytopenia: hemoglobin, 9 g/dL; white blood count, 0.40 × 109/L; platelets, 16 × 109/L; associated with acute renal failure: glomerular filtration rate of 18 mL/min/1.73 m2. Serum folic acid was at 18.6 nmol/L. The clinical examination showed signs of sepsis and mucositis; patient was transferred to the intensive care unit. A bone marrow aspirate showed a poor smear with granular hypoplasia associated with major signs of erythroid dysplasia ([Figure 1]a, [Figure 1]b, [Figure 1]c, [Figure 1]d, [Figure 1]e, [Figure 1]f, May-Grünwald Giemsa Staining, original magnification ×1000). No sign of hemophagocytic syndrome was observed and karyotype analysis was normal. The diagnosis of a MTX-related pancytopenia with induced dysplasia was retained. Folic acid rescue and granulocyte-colony-stimulating-factor therapy were initiated. At day 3 of the last injection, MTX level was still detectable at 0.08 μmol/L. In less than a week, biological analysis was strictly normal. | Figure 1: (a-f) Erythroblast with major signs of dysplasia, using, May-Grünwald Giemsa Staining, original magnification x1000.
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Even though low-dose MTX is usually well tolerated, mild-to-severe adverse effects have been described. MTX-related pancytopenia is a rare side effect and its early detection is a challenging task. It can occur at any point during therapy and is generally independent of the dose.
Acknowledgments
Nicolas Athanase wrote the manuscript, analyzed and collected data.
Elise Frébet collected, analyzed data and reviewed manuscript
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
[Figure 1]
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