A 50-year-old man is brought to the hospital due to refuse to eat over the past 2 days. He states that he has mouth ulcers which are very painful. He has a history of chronic kideny disease and a recent psoriasis diagnosis for which he takes a methotrexate therapy. His therapy regimen is supposed to be every 3 days but he reports taking his medication every day. Temperature is 38.1 C (100.6 F). Examination reveals multiple aphthous ulcers in the oral pharynx. A complete blood cell count is as follows: Which of the following is the best next step in management?

Question

A 50-year-old man is brought to the hospital due to refuse to eat over the past 2 days. He states that he has mouth ulcers which are very painful. He has a history of chronic kideny disease and a recent psoriasis diagnosis for which he takes a methotrexate therapy. His therapy regimen is supposed to be every 3 days but he reports taking his medication every day. Temperature is 38.1 C (100.6 F).  Examination reveals multiple aphthous ulcers in the oral pharynx.  A complete blood cell count is as follows:  Which of the following is the best next step in management?

Quizplus · Accepted Answer

Eductional Objective: Folinic acid (leucovorin) can reverse the toxicity of methotrexate in non-cancerous cells in the gastrointestinal mucosa and bone marrow if administered at the appropriate time.  Leucovorin serves as a reduced form of folic acid that does not require the action of dihydrofolate reductase.

A 50-Year-Old Man Is Brought to the Hospital Due to Refuse