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CASE REPORT article

Front. Pediatr.
Sec. Pediatric Critical Care
Volume 12 - 2024 | doi: 10.3389/fped.2024.1424919

Role of molecular adsorbent recirculating system in methotrexate-induced acute liver failure: a case report and review of the literature

Provisionally accepted
Tiphaine Corbisier Tiphaine Corbisier 1,2*André O. von Bueren André O. von Bueren 2Willemijn Breunis Willemijn Breunis 3Serge Grazioli Serge Grazioli 2
  • 1 Hôpitaux universitaires de Genève (HUG), Genève, Switzerland
  • 2 University Hospitals of Geneva, Geneva, Geneva, Switzerland
  • 3 University Hospital Zürich, Zurich, Zürich, Switzerland

The final, formatted version of the article will be published soon.

    We describe a 14-year-old girl with osteosarcoma who was treated with high dose methotrexate (12g/m2). Twenty-four hours after the infusion, her plasma methotrexate concentration was elevated at 937 μmol/L (normal < 10 µmol/). She exhibited severe signs of methotrexate toxicity, including encephalopathy, acute liver failure, and acute kidney injury. The patient underwent extracorporeal epuration treatment for methotrexate prior to regaining normalized renal and hepatic function.In this case report, we describe severe and rare adverse effects secondary to methotrexate administration and the efficacity of MARS (Molecular Adsorbent Recirculating System) and CVVHDF (Continuous Veno-Venous Hemodiafiltration) to recover from multiple organ failure.

    Keywords: Methotrexate toxicity, acute liver failure, Acute Kidney Injury, Extracorporeal treatment, case report

    Received: 28 Apr 2024; Accepted: 24 Jul 2024.

    Copyright: © 2024 Corbisier, von Bueren, Breunis and Grazioli. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence: Tiphaine Corbisier, Hôpitaux universitaires de Genève (HUG), Genève, Switzerland

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