Severe bone marrow suppression following single-dose methotrexate treatment for ectopic pregnancy

Methotrexate is associated with multisystem side effects which depend on the dosage, route of administration and length of treatment. Bone marrow suppression is a very rare but one of the most mortal complications. A case of severe bone marrow suppression following single dose methotrexate for ectopic pregnancy was presented in this study. A 33-year-old woman, diagnosed as ectopic pregnancy, was given single-dose intramuscular methotrexate of 50 mg/m². On 10th day patient was admitted with lethargy, irritability, vomiting, hematemesis, diarrhea, oral mucositis and skin rash. Laboratory findings revealed severe bone marrow suppression. Supportive treatment together with antibacterial/ antifungal drugs and granulocyte colony stimulating factors were administered. On the 3rd day of treatment, mucositis and oral intake began to improve. After 1 week complete blood count was normal. Methotrexate may have mortal clinical consequences even with very low doses. Therefore, a careful patient history for patient selection and closer clinical follow-up are essential.