What does this research mean for the field?

Conventional low-dose methotrexate can cause fatal intoxication and irreversible multiorgan failure in elderly patients with end-stage renal disease due to severely impaired drug clearance. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

To document a fatal case of severe methotrexate intoxication resulting from conventional low-dose therapy in an elderly individual with unmanaged end-stage renal disease.

August 23, 2026MedicineOpen Access

Fatal intoxication caused by conventional-dose methotrexate in an elderly patient with end-stage renal disease

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Authors

QHQian HeShanxi Medical University XHXu HuangThe Affiliated Yongchuan Hospital of Chongqing Medical University

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Implication

Case report demonstrates fatal methotrexate toxicity and multiorgan failure in an elderly patient with end-stage renal disease, highlighting the strict contraindication of conventional dosing.

Key Points

To document a fatal case of severe methotrexate intoxication resulting from conventional low-dose therapy in an elderly individual with unmanaged end-stage renal disease.
Clinical case evaluation of a 71-year-old male with rheumatoid arthritis and untreated stage 5 chronic kidney disease who received weekly subcutaneous methotrexate (10 mg) for 3 consecutive weeks without folate supplementation.
Serial monitoring of serum methotrexate concentrations and implementation of supportive intensive care, including leucovorin rescue, continuous renal replacement therapy, mechanical ventilation, and broad-spectrum antimicrobial therapy.
The patient developed profound bone marrow suppression, extensive oral and cutaneous ulcerations, septic shock, and persistent drug accumulation due to impaired renal elimination.
Despite aggressive multi-modal interventions including renal replacement therapy and leucovorin rescue, serial serum methotrexate remained elevated and the patient died from refractory septic shock and multiple organ dysfunction syndrome.

Cite This Study

He et al. (2026) studied this question.

synapsesocial.com/papers/6a8aadc57677a341144461d9 https://doi.org/10.1097/md.0000000000050331

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Implication

Case report demonstrates fatal methotrexate toxicity and multiorgan failure in an elderly patient with end-stage renal disease, highlighting the strict contraindication of conventional dosing.

Fatal intoxication caused by conventional-dose methotrexate in an elderly patient with end-stage renal disease

Discussion

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Implication

Key Points

Cite This Study

Fatal intoxication caused by conventional-dose methotrexate in an elderly patient with end-stage renal disease

Discussion

Member takes

Implication

Key Points

Cite This Study

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