Pancytopenia and colitis with Clostridium difficile in a rheumatoid arthritis patient taking methotrexate, antibiotics and non-steroidal anti-inflammatory drugs

Clin Rheumatol. 2001;20(1):73-5. doi: 10.1007/pl00011187.


Methotrexate (MTX) is widely used despite its side-effects. We describe a rheumatoid arthritis (RA) patient taking low-dose MTX who developed severe pancytopenia and colitis with Clostridium difficile after the administration of antibiotics for acute pyelonephritis. Our case suggests that low-dose MTX may seriously interact with antibiotics and that these side-effects should always be considered when RA patients are treated with MTX and antibiotics.

Publication types

  • Case Reports

MeSH terms

  • Aged
  • Anti-Bacterial Agents / therapeutic use*
  • Anti-Inflammatory Agents, Non-Steroidal / therapeutic use*
  • Arthritis, Rheumatoid / complications
  • Arthritis, Rheumatoid / drug therapy*
  • Clostridioides difficile*
  • Drug Interactions
  • Enterocolitis, Pseudomembranous / complications
  • Enterocolitis, Pseudomembranous / microbiology*
  • Female
  • Humans
  • Methotrexate / adverse effects
  • Methotrexate / therapeutic use*
  • Pancytopenia / complications*


  • Anti-Bacterial Agents
  • Anti-Inflammatory Agents, Non-Steroidal
  • Methotrexate