We report a 56-year-old male hemodialysis patient who developed fatal pancytopenia after treatment with low-dose methotrexate for psoriasis and psoriatic arthropathy. Risk factors identified included impaired renal function, concurrent use of nonsteroidal anti-inflammatory drugs, low serum albumin, and relatively low serum folate level. Literature review found similar risk factors in 12 other cases. Therefore, methotrexate, even as a single dose, should not be used to treat rheumatic conditions in dialysis patients.
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