Hyperpigmentation, severe alopecia, and six days of instability in a case of severe methotrexate hypersensitivity reaction

Daru. 2021 Jun;29(1):205-209. doi: 10.1007/s40199-020-00379-0. Epub 2021 Jan 6.


Introduction: Ectopic pregnancy (EP) is an emergency condition in the gynecologic field. Methotrexate (MTX) is a drug of choice for the medical treatment of EP. Severe adverse events are rare among patients treated with MTX for this condition.

Reason for report: We describe a woman with severe multi-organ involvement experiencing about six days of instability after treatment with just a single-dose MTX for EP. This life-threatening condition is not common with a single dose of MTX. A 30-year-old healthy woman was treated medically with MTX for an EP. Three days later the patient was admitted to the emergency department of our hospital with generalized pustular rashes, alopecia, hyperpigmentation, nausea and vomiting, oral ulcers, and raised Creatinine level. Four days later due to pancytopenia, fever, and loss of consciousness, she was transferred to the intensive care unit and was intubated.

Outcome: After 38 days of hospitalization, treatment was successful with leucovorin and supportive care and the patient's symptoms and clinical manifestations were regressed.

Keywords: Methotrexate; Side effects; ectopic pregnancy; toxicity.

Publication types

  • Case Reports

MeSH terms

  • Abortifacient Agents, Nonsteroidal / adverse effects*
  • Adult
  • Alopecia / chemically induced
  • Alopecia / therapy
  • Anti-Bacterial Agents / therapeutic use
  • Drug Hypersensitivity / etiology*
  • Drug Hypersensitivity / therapy
  • Erythropoietin / therapeutic use
  • Female
  • Fever / chemically induced
  • Fever / therapy
  • Granulocyte Colony-Stimulating Factor / therapeutic use
  • Humans
  • Hyperpigmentation / chemically induced
  • Hyperpigmentation / therapy
  • Meropenem / therapeutic use
  • Methotrexate / adverse effects*
  • Pancytopenia / chemically induced
  • Pancytopenia / therapy
  • Platelet Transfusion
  • Pregnancy
  • Pregnancy, Ectopic / drug therapy
  • Pseudomonas Infections / drug therapy
  • Pseudomonas aeruginosa
  • Unconsciousness / chemically induced
  • Unconsciousness / therapy


  • Abortifacient Agents, Nonsteroidal
  • Anti-Bacterial Agents
  • Erythropoietin
  • Granulocyte Colony-Stimulating Factor
  • Meropenem
  • Methotrexate