Severe Pancytopenia Induced by Low-dose Methotrexate in a Hemodialysis Patient

Methotrexate has been used as an important alternative therapy in the treatment of various rheumatic diseases. It is primarily cleared by the kidney. Life-threatening marrow suppression in hemodialysis patients has been reported. A 35-year-old woman undergoing hemodialysis developed severe stomatitis and pancytopenia after low-dose methotrexate treatment for rheumatoid arthritis. She recovered after folinic acid, granulocyte colony-stimulating factor, antibiotic and daily hemodialysis therapy.