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Forensic Sci Int. 2006 Jan 27;156(2-3):154-7. Epub 2005 Dec 15.

Iatrogenically-related, fatal methotrexate intoxication: a series of four cases.

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  • 1Institut für Gerichtliche Medizin der Universität Tübingen, Nägelestr. 5, 72074 Tübingen, Germany.


Since the early eighties, the folic antagonist methotrexate (MTX) has been used in long-term treatment of rheumatoid arthritis. Because of the high toxic potential clinical and laboratory controls at regular intervals and patient education in order to avoid misadventure is of overriding importance. We present four cases of fatal MTX intoxication due to medical malpractice from the Tübingen Institute of Forensic Medicine autopsy material, which show the severe consequences of MTX overdose. It becomes evident that among non-rheumatologists there still is need for information about toxicity and dose limitation in MTX low-dose treatment.

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