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This case study aims to highlight the risks of methotrexate toxicity in patients with renal impairment, despite normal serum concentrations.

June 14, 2026Clinical Case ReportsOpen Access

Methotrexate Toxicity in a Patient With Renal Failure Despite a Normal Methotrexate Concentration: A Case Report and Literature Review

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Case report reveals methotrexate toxicity signs in a patient with renal failure, indicating serum levels may be unreliable.

This case study aims to highlight the risks of methotrexate toxicity in patients with renal impairment, despite normal serum concentrations.
Clinical evaluation of a 58-year-old man with rheumatoid arthritis and chronic kidney disease.
Assessment and management included laboratory investigations, hemodialysis, and leucovorin therapy.
All alternative causes for symptoms were investigated and excluded.
Despite a normal methotrexate serum level, clinical findings indicated toxicity.
Patient presented with gastrointestinal symptoms, neurologic impairment, and developed acute pancreatitis.
The patient ultimately died, emphasizing the need for careful clinical assessment.

Afra et al. (2026) studied this question.

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