{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T12:31:28Z","timestamp":1787142688380,"version":"build-2736575974"},"reference-count":15,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"Suppl 1","license":[{"start":{"date-parts":[[2026,1,23]],"date-time":"2026-01-23T00:00:00Z","timestamp":1769126400000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>\n                    Acute methotrexate toxicity represents a serious medical emergency with significant morbidity and mortality. This case series aims to characterize clinical presentations, risk factors, and outcomes of patients with acute methotrexate toxicity admitted to a tertiary care hospital. We retrospectively analyzed six patients who presented with acute methotrexate toxicity. Clinical presentations, laboratory parameters, management strategies, and outcomes were evaluated. All patients received leucovorin rescue therapy and supportive care. The cohort comprised six patients (median age 63 years, range 54\u201396 years) with 67% female predominance. All patients presented with mucocutaneous manifestations, predominantly oral ulcers (100%). Pancytopenia was observed in all cases with available complete blood counts. Dosing errors were the primary etiology in 67% of cases, with patients erroneously taking weekly doses daily. Additional risk factors included advanced age and chronic kidney disease. Laboratory findings revealed severe neutropenia (median total leukocyte count range 480\u20135300 cells\/mm\n                    <jats:sup>3<\/jats:sup>\n                    ), with progressive hematological deterioration requiring intensive monitoring. Treatment consisted of immediate methotrexate discontinuation, leucovorin rescue therapy (15 mg IV), granulocyte colony-stimulating factor in severe cases, and supportive care. Five patients (83%) recovered completely within 5\u201314 days, while one elderly patient with chronic kidney disease died from complications, yielding a 17% mortality rate. Acute methotrexate toxicity results primarily from dosing errors. Mucocutaneous ulcers serve as early warning signs of systemic toxicity. Early recognition, prompt leucovorin rescue therapy, and aggressive supportive care are crucial for favorable outcomes. Enhanced patient education and monitoring protocols are essential for prevention.\n                  <\/jats:p>","DOI":"10.4103\/aam.aam_431_25","type":"journal-article","created":{"date-parts":[[2026,1,27]],"date-time":"2026-01-27T02:00:13Z","timestamp":1769479213000},"page":"S76-S80","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["A Case series of Acute Methotrexate Toxicity"],"prefix":"10.4103","volume":"25","author":[{"given":"Anand","family":"Dugad","sequence":"first","affiliation":[{"name":"Department of General Medicine, Dr. D. Y. Patil Medical College and Research Centre, Pune, Maharashtra, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammed Hassan","family":"Shaik","sequence":"additional","affiliation":[{"name":"Department of General Medicine, Dr. D. Y. Patil Medical College and Research Centre, Pune, Maharashtra, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rahul","family":"Patil","sequence":"additional","affiliation":[{"name":"Department of General Medicine, Dr. D. Y. Patil Medical College and Research Centre, Pune, Maharashtra, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vikram","family":"Vikhe","sequence":"additional","affiliation":[{"name":"Department of General Medicine, Dr. D. Y. Patil Medical College and Research Centre, Pune, Maharashtra, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Isha","family":"Desai","sequence":"additional","affiliation":[{"name":"Department of General Medicine, Dr. D. Y. Patil Medical College and Research Centre, Pune, Maharashtra, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2026,1,23]]},"reference":[{"key":"R1-20260819","first-page":"e29518","article-title":"Overview of methotrexate toxicity: A comprehensive literature review","volume":"14","author":"Hamed","year":"2022","journal-title":"Cureus"},{"key":"R2-20260819","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1177\/09733698241229913","article-title":"Clinical profile of acute methotrexate toxicity in rheumatic diseases: A series of 15 cases","volume":"19","author":"Mruthyunjaya","year":"2024","journal-title":"Indian J Rheumatol"},{"key":"R3-20260819","doi-asserted-by":"crossref","first-page":"e15945","DOI":"10.1111\/dth.15945","article-title":"Fatal low-dose methotrexate toxicity: A case report and literature review","volume":"35","author":"Ouellette","year":"2022","journal-title":"Dermatol Ther"},{"key":"R4-20260819","first-page":"339","article-title":"Low-dose methotrexate toxicity leading to pancytopenia: Leucovorin as a rescue treatment","volume":"37","author":"Schelzel","year":"2024","journal-title":"Proc (Bayl Univ Med Cent)"},{"key":"R5-20260819","doi-asserted-by":"crossref","first-page":"e15765","DOI":"10.1111\/dth.15765","article-title":"Methotrexate toxicity in psoriasis-a multicentric retrospective study","volume":"35","author":"Singh","year":"2022","journal-title":"Dermatol Ther"},{"key":"R6-20260819","doi-asserted-by":"crossref","first-page":"473","DOI":"10.4103\/idoj.idoj_567_23","article-title":"Mucocutaneous ulcers unmasking severe systemic methotrexate toxicity \u2013 A case-series and review of literature","volume":"15","author":"Janet","year":"2024","journal-title":"Indian Dermatol Online J"},{"key":"R7-20260819","doi-asserted-by":"crossref","first-page":"82","DOI":"10.1186\/s13075-023-03054-2","article-title":"Comparison of two doses of leucovorin in severe low-dose methotrexate toxicity \u2013 A randomized controlled trial","volume":"25","author":"Bhargava","year":"2023","journal-title":"Arthritis Res Ther"},{"key":"R8-20260819","doi-asserted-by":"crossref","first-page":"1109","DOI":"10.1016\/j.autrev.2014.08.027","article-title":"Clinical characteristics and risk factors for low dose methotrexate toxicity: A cohort of 28 patients","volume":"13","author":"Kivity","year":"2014","journal-title":"Autoimmun Rev"},{"key":"R9-20260819","doi-asserted-by":"crossref","first-page":"1471","DOI":"10.1634\/theoncologist.2015-0164","article-title":"Preventing and managing toxicities of high-dose methotrexate","volume":"21","author":"Howard","year":"2016","journal-title":"Oncologist"},{"key":"R10-20260819","doi-asserted-by":"crossref","first-page":"1246","DOI":"10.3122\/jabfm.2021.06.210120","article-title":"Methotrexate toxicity from unintentional dosing errors: Calls to a poison center and death descriptions","volume":"34","author":"Thompson","year":"2021","journal-title":"J Am Board Fam Med"},{"key":"R11-20260819","doi-asserted-by":"crossref","first-page":"1051","DOI":"10.1093\/rheumatology\/keh685","article-title":"Methotrexate-induced pancytopenia: Serious and under-reported? Our experience of 25 cases in 5 years","volume":"44","author":"Lim","year":"2005","journal-title":"Rheumatology (Oxford)"},{"key":"R12-20260819","doi-asserted-by":"crossref","first-page":"846","DOI":"10.1111\/1756-185X.13004","article-title":"Methotrexate-induced pancytopenia: A case series of 46 patients","volume":"20","author":"Ajmani","year":"2017","journal-title":"Int J Rheum Dis"},{"key":"R13-20260819","doi-asserted-by":"crossref","first-page":"e003827","DOI":"10.1136\/rmdopen-2023-003827","article-title":"Severe methotrexate toxicity in elderly patients under diuretics","volume":"10","author":"Kumar","year":"2024","journal-title":"RMD Open"},{"key":"R14-20260819","doi-asserted-by":"crossref","first-page":"1557","DOI":"10.1111\/1756-185X.13339","article-title":"Methotrexate intoxication: Beyond the adverse events","volume":"21","author":"Dalkilic","year":"2018","journal-title":"Int J Rheum Dis"},{"key":"R15-20260819","first-page":"143","article-title":"Methotrexate toxicity in patients with rheumatic diseases: A 10-year evaluation of manifestations, risk factors, and mortality","volume":"9","author":"Shenavandeh","year":"2024","journal-title":"Rheumatol Res"}],"container-title":["Annals of African Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.4103\/aam.aam_431_25","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T12:01:39Z","timestamp":1787140899000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.4103\/aam.aam_431_25"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,23]]},"references-count":15,"journal-issue":{"issue":"Suppl 1","published-print":{"date-parts":[[2026]]}},"URL":"https:\/\/doi.org\/10.4103\/aam.aam_431_25","relation":{},"ISSN":["1596-3519","0975-5764"],"issn-type":[{"value":"1596-3519","type":"print"},{"value":"0975-5764","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,23]]},"assertion":[{"value":"2025-08-17","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-10-10","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}