Abstract:

A case of severe adverse reaction after a single-dose methotrexate combined with mifepristone for ectopic pregnancy is reported. After receiving drug treatment for ectopic pregnancy at an outside hospital, the patient developed high fever, oral ulcers, rashes, diarrhea, and bone marrow suppression. Due to the failure of timely recognition and treatment, the condition progressed to severe complications such as grade Ⅳ oral mucositis, grade Ⅳ bone marrow suppression, septic shock, and multiple organ dysfunction. After being transferred to our hospital, the patient finally improved after active treatments including calcium folinate rescue, anti-infection, granulocyte stimulating factor therapy, total parenteral nutrition, and blood product transfusions. Currently, all guidelines for the drug treatment of ectopic pregnancy recommend a single-dose of methotrexate, and multiple-doses if necessary. The combined use of methotrexate and mifepristone is not recommended. Medical staff should be aware of the adverse reactions of the drugs and strengthens monitoring. Once the aforementioned adverse reactions occur, early recognition and standardized treatment can prevent the occurrence of severe complications.

Key words: Methotrexate, Mifepristone, Pregnancy, ectopic, Mucositis, Myelosuppression