Document Detail

Life-threatening complications following multidose methotrexate for medical management of ectopic pregnancy.
MedLine Citation:
PMID:  22922914     Owner:  NLM     Status:  In-Data-Review    
A 25-year-old primigravida was diagnosed to be suffering from unruptured ectopic pregnancy. The serum β-human chorionic gonadotropin levels were 2851 mIU/l and the ectopic gestational sac was 2.7×2.7 cm without any fetal pole. It was decided to manage her by expectant therapy. But she received medical therapy with multidose methotrexate because of misinterpretation of expectant therapy as medical therapy. She suffered from methotrexate toxicity, which manifested as high-grade fever, vomiting, melena, oral ulcerations, pneumonitis, subconjunctival haemorrhages and skin pigmentation. She developed severe third space fluid collection and shock, which was mistaken for rupture ectopic gestation. Her haematological picture showed severe neutropaenia and thrombocytopaenia which confirmed the clinical picture to be due to methotrexate toxicity. She also developed septicaemia and candidal infection secondary to immunosuppression. She was managed in intensive care unit with ventilatory support, high-dose leucovorin and injection filgastrim. She responded well to the therapy with dramatic recovery in 4 days.
Papa Dasari; Haritha Sagili
Publication Detail:
Type:  Journal Article     Date:  2012-08-24
Journal Detail:
Title:  BMJ case reports     Volume:  2012     ISSN:  1757-790X     ISO Abbreviation:  BMJ Case Rep     Publication Date:  2012  
Date Detail:
Created Date:  2012-08-27     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101526291     Medline TA:  BMJ Case Rep     Country:  England    
Other Details:
Languages:  eng     Pagination:  -     Citation Subset:  IM    
Department of Obstetrics and Gynaecology, JIPMER, Puducherry, India.
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