{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T14:52:29Z","timestamp":1791643949455,"version":"4.3.4"},"reference-count":19,"publisher":"BMJ","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Reports"],"accepted":{"date-parts":[[2018,4,30]]},"abstract":"<jats:p>Methotrexate is one of the most commonly used drugs in autoimmune disorders like rheumatoid arthritis. Gastrointestinal symptoms like nausea and stomatitis, skin rashes, alopecia, central nervous system symptoms like headache and confusion, hepatotoxicity and myelosuppression are some of the adverse effects. However, low oral doses on a weekly basis seldom show any signs of toxicity. Leucovorin or folinic acid is given along with methotrexate as rescue to reduce the toxic effects like bone marrow suppression. Non-steroidal anti-inflammatory drugs, like aceclofenac, are also used in chronic inflammatory conditions like rheumatoid arthritis and osteoarthritis. Nephrotoxicity is one of the adverse effects of both methotrexate and non-steroidal anti-inflammatory drugs; and its combined administration should be done with caution. This is a case of an elderly woman, a known case of rheumatoid arthritis, who presented in severe bone marrow suppression due to methotrexate toxicity following aceclofenac-induced acute kidney injury.<\/jats:p>","DOI":"10.1136\/bcr-2018-224722","type":"journal-article","created":{"date-parts":[[2018,6,5]],"date-time":"2018-06-05T09:06:27Z","timestamp":1528189587000},"page":"bcr-2018-224722","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":8,"title":["Severe bone marrow suppression due to methotrexate toxicity following aceclofenac-induced acute kidney injury"],"prefix":"10.1136","volume":"2018","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3973-6800","authenticated-orcid":false,"given":"Robin George","family":"Manappallil","sequence":"first","affiliation":[{"name":"Internal Medicine, Baby Memorial Hospital, Calicut, Kerala, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Durga","family":"Prasan","sequence":"additional","affiliation":[{"name":"Medical Oncology, Baby Memorial Hospital, Calicut, Kerala, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jayameena","family":"Peringat","sequence":"additional","affiliation":[{"name":"Nephrology, Baby Memorial Hospital, Calicut, Kerala, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Illolil Kuniyil","family":"Biju","sequence":"additional","affiliation":[{"name":"Medical Gastroenterology, Baby Memorial Hospital, Calicut, Kerala, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2018,6,5]]},"reference":[{"key":"2025082707154297000_2018.jun04_3.bcr-2018-224722.1","doi-asserted-by":"publisher","DOI":"10.1093\/ckj\/sfs008"},{"key":"2025082707154297000_2018.jun04_3.bcr-2018-224722.2","doi-asserted-by":"crossref","first-page":"38","DOI":"10.5935\/0101-2800.20150007","article-title":"Predictors of acute kidney injury and mortality in an Intensive Care Unit","volume":"37","author":"Peres","year":"2015","journal-title":"J Bras Nefrol"},{"key":"2025082707154297000_2018.jun04_3.bcr-2018-224722.3","first-page":"1018","article-title":"The metabolic fate of tritiated methotrexate. II. Absorption and excretion in man","volume":"25","author":"Henderson","year":"1965","journal-title":"Cancer Res"},{"key":"2025082707154297000_2018.jun04_3.bcr-2018-224722.4","first-page":"101","article-title":"Adverse effects of low dose methotrexate in rheumatoid arthritis patients","volume":"22","author":"Gilani","year":"2012","journal-title":"J Coll Physicians Surg Pak"},{"key":"2025082707154297000_2018.jun04_3.bcr-2018-224722.5","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-107-2-418"},{"key":"2025082707154297000_2018.jun04_3.bcr-2018-224722.6","doi-asserted-by":"crossref","first-page":"480","DOI":"10.5694\/j.1326-5377.1991.tb93847.x","article-title":"Neutropenia due to low-dose methotrexate therapy for psoriasis and rheumatoid arthritis may be fatal","volume":"155","author":"Mayall","year":"1991","journal-title":"Med J Aust"},{"key":"2025082707154297000_2018.jun04_3.bcr-2018-224722.7","doi-asserted-by":"crossref","first-page":"951","DOI":"10.1007\/BF00180446","article-title":"Three cases of malignant neoplasm, pneumonitis, and pancytopenia during treatment with low-dose methotrexate","volume":"70","author":"Trenkwalder","year":"1992","journal-title":"Clin Investig"},{"key":"2025082707154297000_2018.jun04_3.bcr-2018-224722.8","doi-asserted-by":"publisher","DOI":"10.1258\/jrsm.97.11.536"},{"key":"2025082707154297000_2018.jun04_3.bcr-2018-224722.9","first-page":"50","article-title":"Disposition kinetics of sulphadiazine in normal and diabetic rabbits","volume":"39","author":"Iqbal","year":"1989","journal-title":"J Pak Med Assoc"},{"key":"2025082707154297000_2018.jun04_3.bcr-2018-224722.10","unstructured":"Messmann R , Antifolates AC , In Chabner B , Longo D , et al . Cancer chemotherapy and biotherapy. 10th edn. Philadelphia: Lippincott Williams & Wilkins, 2001:139\u201384."},{"key":"2025082707154297000_2018.jun04_3.bcr-2018-224722.11","doi-asserted-by":"publisher","DOI":"10.1007\/s002800050406"},{"key":"2025082707154297000_2018.jun04_3.bcr-2018-224722.12","doi-asserted-by":"publisher","DOI":"10.1093\/rheumatology\/41.6.658"},{"key":"2025082707154297000_2018.jun04_3.bcr-2018-224722.13","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD000951"},{"key":"2025082707154297000_2018.jun04_3.bcr-2018-224722.14","first-page":"632","article-title":"NSAIDs and kidney","volume":"52","author":"Ejaz","year":"2004","journal-title":"J Assoc Physicians India"},{"key":"2025082707154297000_2018.jun04_3.bcr-2018-224722.15","doi-asserted-by":"crossref","unstructured":"Gupta M , Cruz SD , Nada R , et al . Aceclofenac-induced acute tubulointerstitial nephritis in a patient with diabetes. Case Rep Child Meml Hosp Chic 2013.","DOI":"10.1136\/bcr-2013-009217"},{"key":"2025082707154297000_2018.jun04_3.bcr-2018-224722.16","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1155\/2015\/294041","article-title":"Macrophage activation syndrome as onset of systemic lupus erythematosus: A case report and a review of the literature","volume":"2015","author":"Granata","year":"2015","journal-title":"Case Rep Med"},{"key":"2025082707154297000_2018.jun04_3.bcr-2018-224722.17","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.326.7383.266"},{"key":"2025082707154297000_2018.jun04_3.bcr-2018-224722.18","doi-asserted-by":"publisher","DOI":"10.1345\/aph.1A052"},{"key":"2025082707154297000_2018.jun04_3.bcr-2018-224722.19","first-page":"1144","article-title":"[Pancytopenia in rheumatoid arthritis treated with methotrexate]","volume":"25","author":"Laroche","year":"1996","journal-title":"Presse Med"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2018-224722","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T14:15:49Z","timestamp":1756304149000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2018-224722"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,6,5]]},"references-count":19,"alternative-id":["10.1136\/bcr-2018-224722"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2018-224722","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,6,5]]}}}