Abstract
Methotrexate (MTX) is a drug therapy for rheumatoid arthritis. Here we report two cases in which MTX caused severe stomatitis. Case 1 was an 83-year-old woman who presented in our department with stomatitis and eating disorder. Blood tests revealed pancytopenia. Treatment with granulocyte colony stimulating factor (G-CSF) was started and a blood transfusion of platelet concentrate was administered. She was also examined in the Department of Nephrology for renal dysfunction and started on hemodialysis. Our department provided pain relief for stomatitis and infection prevention. Case 2 was a 77-year-old woman who presented in our department with stomatitis and eating disorder. Blood tests revealed pancytopenia, severe renal dysfunction. Treatment with G-CSF, intravenous antibiotics infusion, and oral antifungals was started. By day 7, the pancytopenia and stomatitis was improving. MTX is believed to cause stomatitis as a precursor to the development of pancytopenia, and if risk factors for the appearance of MTX side effects are present, it is important for clinicians to be particularly careful of this possibility.
