{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T15:10:01Z","timestamp":1756307401261,"version":"3.44.0"},"reference-count":11,"publisher":"BMJ","issue":"5","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2019,5,10]]},"published-print":{"date-parts":[[2019,5,31]]},"abstract":"<jats:p>Methotrexate (MTX) was originally formulated as one of the first antitumour drugs due to its ability to alter folate metabolism, which renders it to be an antiproliferative agent. Classically, the higher dosage is administered via parenteral route, in a cyclical fashion, to achieve antitumour effects. Patients on high doses of MTX are prone to develop rare complications of myelosuppression and pancytopenia, in a dose-dependent fashion, secondary to altered folate metabolism.\n<jats:sup>1<\/jats:sup>\n Herein, we present a unique case of rheumatoid arthritis presented with pancytopenia due to low-dose MTX and doxycycline drug interaction. We also report the successful management of pancytopenia and oral ulcers with combination therapy of leucovorin and granulocyte colony-stimulating factor.<\/jats:p>","DOI":"10.1136\/bcr-2019-229296","type":"journal-article","created":{"date-parts":[[2019,6,1]],"date-time":"2019-06-01T07:45:17Z","timestamp":1559375117000},"page":"e229296","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":5,"title":["Methotrexate and doxycycline interaction: a rare cause of pancytopenia"],"prefix":"10.1136","volume":"12","author":[{"given":"Ahmad","family":"Arslan","sequence":"first","affiliation":[{"name":"Abington Hospital - Jefferson Health, Abington, Pennsylvania, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Muhammad Abdullah","family":"Zain","sequence":"additional","affiliation":[{"name":"Sheikh Zayed Medical College, Rahim Yar Khan, Pakistan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maryam","family":"Mukhtar","sequence":"additional","affiliation":[{"name":"Fauji Foundation Hospital, Rawalpindi, Pakistan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4850-0309","authenticated-orcid":false,"given":"Waqas","family":"Ullah","sequence":"additional","affiliation":[{"name":"Abington Hospital - Jefferson Health, Abington, Pennsylvania, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sohaib","family":"Roomi","sequence":"additional","affiliation":[{"name":"Abington Hospital - Jefferson Health, Abington, Pennsylvania, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2019,5,31]]},"reference":[{"key":"2025082707422184000_12.5.e229296.1","doi-asserted-by":"publisher","DOI":"10.1345\/aph.18236"},{"key":"2025082707422184000_12.5.e229296.2","first-page":"1","article-title":"Methotrexate induced pancytopenia","volume":"2014","author":"Gonzalez-Ibarra","year":"2014","journal-title":"Case Rep Rheumatol"},{"key":"2025082707422184000_12.5.e229296.3","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0154744","article-title":"Factors Associated with Myelosuppression Related to Low-Dose Methotrexate Therapy for Inflammatory Rheumatic Diseases","volume":"11","author":"Mori","year":"2016","journal-title":"PLoS One"},{"key":"2025082707422184000_12.5.e229296.4","first-page":"60","article-title":"Pancytopenia with the first dose of methotrexate in a patient with psoriati c arthritis","volume":"13","author":"Agarwal","year":"2005","journal-title":"J Indian Rheumatol Assoc"},{"key":"2025082707422184000_12.5.e229296.5","doi-asserted-by":"publisher","DOI":"10.1002\/pds.1236"},{"key":"2025082707422184000_12.5.e229296.6","doi-asserted-by":"publisher","DOI":"10.3899\/jrheum.090153"},{"key":"2025082707422184000_12.5.e229296.7","first-page":"594","article-title":"Prevalence of rheumatic diseases in Brazil: a study using the COPCORD approach","volume":"31","author":"Senna","year":"2004","journal-title":"J Rheumatol"},{"key":"2025082707422184000_12.5.e229296.8","doi-asserted-by":"crossref","first-page":"149","DOI":"10.1080\/20009666.2018.1466598","article-title":"A deadly prescription: combination of methotrexate and trimethoprim-sulfamethoxazole","volume":"8","author":"Hamid","year":"2018","journal-title":"J Community Hosp Intern Med Perspect"},{"key":"2025082707422184000_12.5.e229296.9","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1590\/S0482-50042011000100003","article-title":"Potential drug interactions in patients with rheumatoid arthritis","volume":"51","author":"Bagatini","year":"2011","journal-title":"Revista brasileira de reumatologia"},{"key":"2025082707422184000_12.5.e229296.10","first-page":"CMT.S2035","article-title":"Safety and Efficacy Review of Doxycycline","volume":"1","author":"Holmes","year":"2009","journal-title":"Clin Med Ther"},{"key":"2025082707422184000_12.5.e229296.11","doi-asserted-by":"crossref","first-page":"3419","DOI":"10.1007\/s10067-018-4242-8","article-title":"How should we manage low-dose methotrexate-induced pancytopenia in patients with rheumatoid arthritis?","volume":"37","author":"Cansu","year":"2018","journal-title":"Clin Rheumatol"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2019-229296","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T14:42:30Z","timestamp":1756305750000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2019-229296"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,5,31]]},"references-count":11,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2019,5,31]]},"published-print":{"date-parts":[[2019,5,31]]}},"alternative-id":["10.1136\/bcr-2019-229296"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2019-229296","relation":{},"ISSN":["1757-790X"],"issn-type":[{"type":"electronic","value":"1757-790X"}],"subject":[],"published":{"date-parts":[[2019,5,31]]}}}