Methotrexate/prednisolone Reactions 1680, p225 - 2 Dec 2017 Various toxicities: case report A 53-year-old man developed septic shock, disseminated intravascular coagulation (DIC), acute respiratory distress syndrome (ARDS) and bacterial sepsis secondary to Capnocytophaga canimorsus infection during treatment with methotrexate and prednisolone [not all routes stated]. Subsequently, he died due to Capnocytophaga canimorsus infection. The man, who had been receiving oral methotrexate 10 mg/week along with low-dose prednisolone 2 mg/day for 5 years as a treatment of rheumatoid arthritis, presented with a 3 day history of fever and dyspnoea. Four days prior to the fever and dyspnoea onset, his pet dog bit him on his left index finger; however, on examination there was no signs of cellulitis and erythema. After the exacerbation of his symptoms, he was hospitalised. At admission, he had had a BP of 63/52mm Hg, HR of 129 beats/min, RR of 40 /min, body temperature of 38.0°C and oxygen saturation of 100%. Laboratory investigations were remarkable for pancytopenia, high-grade inflammatory status and renal impairment. Coagulation studies revealed prolonged prothrombin time and increased fibrin/fibrinogen degradation products. These findings were indicative of a septic shock and DIC. A chest CT scan showed ground glass opacity with consolidation in the sub-pleural regions of the bilateral lower lobes. Thereafter, the man was transferred to the ICU, where he received massive fluid replacement, and was administered a single dose of meropenem. Moreover, he required platelet transfusion and nafamostat [nafamostat mesilate] to treat sepsis-related DIC. Despite massive fluid resuscitation, his hypotension continued. As a result, he received noradrenaline followed by hydrocortisone. On the second day, the intensive treatments did not improve the hypotension, and his respiratory condition worsened. Repeat CT showed progression of consolidations in the bilateral middle and lower lobes and the development of ARDS. Due to the ARDS, he underwent mechanical ventilation. At that time, capnophilic gram-negative rod was identified from his blood cultures. On the basis of clinical course, septic shock, DIC and ARDS secondary to C. canimorsus infection were suspected. However, on the third day, he had pupillary dilation with no light reflex. A head CT demonstrated cerebral haemorrhage and herniation. After a 5 day stay in the ICU, he died. After his death, a species-specific polymerase chain reaction identified C. canimorsus pathogen as the cause of severe sepsis. Author comment: "C. canimorsus infections should be considered in the differential diagnosis of sepsis for immunocompromised hosts following animal bites." "Our case was a rare situation where the subject presented with [methotrexate] associated immunodeficiency in which life- saving procedures were unsuccessful due to septic shock, DIC, and ARDS caused by C. canimorsus infection." Tamura S, et al. Capnocytophaga canimorsus sepsis in a methotrexate-treated patient with rheumatoid arthritis. IDCases 10: 18-21, 5 Aug 2017. Available from: URL: - Japan 803284507 0114-9954/17/1680-0001/$14.95 Adis © 2017 Springer International Publishing AG. All rights reserved Reactions 2 Dec 2017 No. 1680 Reactions Weekly Springer Journals


Reactions Weekly , Volume 1680 (1) – Dec 2, 2017
1 page

Loading next page...
1 Page
Springer International Publishing
Copyright © 2017 by Springer International Publishing AG, part of Springer Nature
Medicine & Public Health; Drug Safety and Pharmacovigilance; Pharmacology/Toxicology
Publisher site
See Article on Publisher Site


You’re reading a free preview. Subscribe to read the entire article.

DeepDyve is your
personal research library

It’s your single place to instantly
discover and read the research
that matters to you.

Enjoy affordable access to
over 12 million articles from more than
10,000 peer-reviewed journals.

All for just $49/month

Explore the DeepDyve Library

Unlimited reading

Read as many articles as you need. Full articles with original layout, charts and figures. Read online, from anywhere.

Stay up to date

Keep up with your field with Personalized Recommendations and Follow Journals to get automatic updates.

Organize your research

It’s easy to organize your research with our built-in tools.

Your journals are on DeepDyve

Read from thousands of the leading scholarly journals from SpringerNature, Elsevier, Wiley-Blackwell, Oxford University Press and more.

All the latest content is available, no embargo periods.

See the journals in your area

Monthly Plan

  • Read unlimited articles
  • Personalized recommendations
  • No expiration
  • Print 20 pages per month
  • 20% off on PDF purchases
  • Organize your research
  • Get updates on your journals and topic searches


Start Free Trial

14-day Free Trial

Best Deal — 39% off

Annual Plan

  • All the features of the Professional Plan, but for 39% off!
  • Billed annually
  • No expiration
  • For the normal price of 10 articles elsewhere, you get one full year of unlimited access to articles.



billed annually
Start Free Trial

14-day Free Trial