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She developed severe third space fluid collection and shock, which was mistaken for rupture ectopic gestation. Her haematological picture showed severe neutropaenia and thrombocytopaenia which confirmed the clinical picture to be due to methotrexate toxicity. She also developed septicaemia and candidal infection secondary to immunosuppression. She was managed in intensive care unit with ventilatory support, high-dose leucovorin and injection filgastrim. She responded well to the therapy with dramatic recovery in 4\u2005days.<\/jats:p>","DOI":"10.1136\/bcr-03-2012-6023","type":"journal-article","created":{"date-parts":[[2012,8,24]],"date-time":"2012-08-24T12:03:58Z","timestamp":1345809838000},"page":"bcr0320126023","source":"Crossref","is-referenced-by-count":14,"title":["Life-threatening complications following multidose methotrexate for medical management of ectopic pregnancy"],"prefix":"10.1136","volume":"2012","author":[{"given":"Papa","family":"Dasari","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynaecology, JIPMER, Puducherry, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haritha","family":"Sagili","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology, JIPMER, Puducherry, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2012,8,24]]},"reference":[{"key":"2025082802012248000_2012.aug22_1.bcr0320126023.1","doi-asserted-by":"crossref","first-page":"435","DOI":"10.1016\/S0015-0282(16)60549-6","article-title":"Outpatient chemotherapy of unruptured ectopic pregnancy","volume":"51","author":"Stovall","year":"1989","journal-title":"Fertil Steril"},{"key":"2025082802012248000_2012.aug22_1.bcr0320126023.2","doi-asserted-by":"publisher","DOI":"10.1016\/0029-7844(96)00252-9"},{"key":"2025082802012248000_2012.aug22_1.bcr0320126023.3","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejogrb.2004.03.003"},{"key":"2025082802012248000_2012.aug22_1.bcr0320126023.4","doi-asserted-by":"publisher","DOI":"10.1016\/j.fertnstert.2010.08.025"},{"key":"2025082802012248000_2012.aug22_1.bcr0320126023.5","first-page":"1005","article-title":"Safety and efficacy of systemic methotrexate in the treatment of unruptured tubal pregnancy","volume":"27","author":"Soliman","year":"2006","journal-title":"Saudi Med J"},{"key":"2025082802012248000_2012.aug22_1.bcr0320126023.6","doi-asserted-by":"publisher","DOI":"10.3109\/00016349.2010.486825"},{"key":"2025082802012248000_2012.aug22_1.bcr0320126023.7","doi-asserted-by":"publisher","DOI":"10.1016\/S0029-7844(02)03158-7"},{"key":"2025082802012248000_2012.aug22_1.bcr0320126023.8","first-page":"87","article-title":"Predictors of methotrexate treatment failure in ectopic pregnancy","volume":"51","author":"Dilbaz","year":"2006","journal-title":"J Reprod Med"},{"key":"2025082802012248000_2012.aug22_1.bcr0320126023.9","doi-asserted-by":"publisher","DOI":"10.1136\/jfprhc-2011-0073"},{"key":"2025082802012248000_2012.aug22_1.bcr0320126023.10","unstructured":"Methotrexate side-effects. http:\/\/www.drugs.com\/sfx\/methotrexate-side-effects.html Methotrexate Official FDA information, side-effects and uses. http:\/\/www.drugs.com\/pro\/methotrexate.html"},{"key":"2025082802012248000_2012.aug22_1.bcr0320126023.11","unstructured":"Methotrexate sensitivity (MTHFR) 2 mutations. 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