Anaphylaxis during the first course of high-dose methotrexate: a case report and literature review

J Clin Pharm Ther. 2012 Apr;37(2):245-8. doi: 10.1111/j.1365-2710.2011.01275.x. Epub 2011 May 13.


What is known and objective: Methotrexate (MTX) is widely used in the management of paediatric cancer with a generally favourable benefit/risk profile. We report an unusual adverse drug reaction with the first course of high-dose MTX in a paediatric patient and review the literature for similar cases.

Case summary: An 11-year-old boy with small-cell osteoblastic osteosarcoma in the lower limb experienced a case of life-threatening anaphylaxis during the first course of high-dose MTX. The adverse event occurred during the first course, likely due to an immune-mediated mechanism. We postulate that prior antineoplastic treatment might have contributed to the immune response to MTX.

What is new and conclusion: Given that this reaction has rarely been reported, we discuss the present case with a review of other similar cases. Further studies are needed to substantiate this 'signal alarm' for serious MTX-related hypersensitivity reactions.

Publication types

  • Case Reports
  • Review

MeSH terms

  • Anaphylaxis / chemically induced*
  • Anaphylaxis / immunology
  • Antimetabolites, Antineoplastic / administration & dosage
  • Antimetabolites, Antineoplastic / adverse effects*
  • Bone Neoplasms / drug therapy
  • Bone Neoplasms / pathology
  • Child
  • Dose-Response Relationship, Drug
  • Drug Hypersensitivity / etiology
  • Drug Hypersensitivity / immunology
  • Humans
  • Male
  • Methotrexate / administration & dosage
  • Methotrexate / adverse effects*
  • Methotrexate / therapeutic use
  • Osteosarcoma / drug therapy
  • Osteosarcoma / pathology


  • Antimetabolites, Antineoplastic
  • Methotrexate