Disclaimer: The author Dr Savio Pereira has not signed details of patient or hospital, and is sharing information available from the Public domain and from his own knowledge. The information is for "pro bono" -for Public good. The Name of the Parties is not mentioned by the Author in his writings. There is no breach in confidentiality
Case studies in Medical Negligence
Case Study No. 5: Blood Cancer (Acute Myeloid Leukemia) developed as a Result of unmonitored treatment with High-dose METHOTREXATE for RA factor Negative patient with Vitamin D Deficiency treated wrongly as Rheumatoid Arthritis
The patient developed Blood cancer as a result on unnecessary treatment which was treated with Bone marrow transplantation.
Learning Outcomes: Adverse outcome and medical negligence
Rheumatoid Arthritis
Medical Subject Topics: Rheumatology, Haematology, Bone Marrow Transplantation, Adverse outcome Vs Medical Negligence, Chemotoxicity
Mrs. XXXX was suffering from BONE PAIN in the Small fingers, which was not diagnosed properly as Vitamin D Deficiency and Wrongly diagnosed as RHEUMATOID ARTHRITIS for JOINT PAIN.
The patient was treated by a Superspecialist Rheumatologist in reputed hospital in Bengaluru.
The patient had no signs of Rheumatoid Arthritis (R A) Factor Positive
Rheumatoid arthritis, and was wrongly investigated, treated with Methotrexate.
The Unnecessary prolonged Methotrexate therapy has led to development of Preventable Therapy related AML Blood cancer.
The State Medical Council has agreed that the BLOOD CANCER is Therapy related. The Point is that the Superspecialist should have investigated for BONE PAIN Causes including Hypocalcemia/Bone density/Vitamin Deficiency -which was diagnosed much later.
The point is that the Superspecialist should have given superspeciality Rheumatology care. The Point is that the THERAPY was not Methotrexate, but Vitamin D and Calcium replacement therapy. The unnecessary Methotrexate treatment has led to Preventable blood cancer.
The blood cancer of Mrs. XXX on account of their gross medical negligence, unethical medical practices and rash and negligent actions at the treatment stage itself -which is directly linked with Methotrexate toxicity (whether at low dose or high dose)
ISSUES
Mrs XXX had no signs, symptoms, Clinical Findings and Diagnostic tests suggestive of SEROPOSITIVE RHEUMATOID ARTHRITIS?
Mrs XXX had no signs, symptoms, Clinical Findings and Diagnostic tests suggestive of SERONEGATIVE RHEUMATOID ARTHRITIS?
It is submitted that the blood cancer in the patient is directly linked to methotrexate toxicity as mentioned in the discharge summary provided by the same hospital verbatim
“In view of long standing arthritis and methotrexate therapy and bone marrow morphological changes, a possiblility of underlying myelodysplasia is quite strong although cytogenetics was normal ”moreover Mrs. XXX did not have any other risk factors predisposing to leukemia as confirmed by a normal cytogenetics report
There have been several reports and case series all around the world in which drug induced pancytopenias and hematological malignancies have developed in autoimmune diseases receiving low dose MTX the citations for which are provided below and the original articles for the same is being procured and will be produced at the later stages if necessary.
Therefore it is submitted that the patient not only developed leukemia as a result of methotrexate toxicity but also at the risk of developing other hematological malignancies as described in the citations
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Dr. Savio Pereira
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