A Suppression of the Bone Marrow caused by Methotrexate among the most Serious and Intricate Adverse Effects: A Case Series

Methotrexate toxicities that have been well-reported are dependent on the drug's duration and cumulative dosage. The time of drug delivery may be used to anticipate the usual toxicities, where mucositis develops early and myelosuppression and pancytopenia's aftereffects develop later after Methotrexate administration. Even with these established hazards, low dosage Methotrexate treatment can still cause issues, especially in older patients who are more likely to experience severe myelosuppression. The American College of Rheumatology recommends performing complete blood count, serum creatinine, and transaminase tests before starting Methotrexate medication, followed by monitoring every 12 weeks for the next three months, and so on. We present a case of a 73-year-old male patient experienced mild tenderness, oral ulcer, decreased appetite, and increased bowel movement. He required intravenous antibiotic therapy and limited transfusion dependence due to low dose daily Methotrexate for rheumatoid arthritis. The other case is of a 68-year-old female patient experienced severe body-ache, weakness, stomatitis, and skin rashes, which were resolved with injection of Leucovorin and folic acid.