MYOCARDIAL INFARCTION UNDER METHOTREXATE IN A PATIENT WITH LOW RISK GESTATIONAL TROPHO BLASTIC NEOPLASIA: A CASE REPORT

Background: Methotrexate, an antifolateantimetabolite, finds extensive application in the field of oncology as well as for managingvariousautoimmunediseases. It isconsidered as backbone treatment for bothlow and high risk, trophoblasticgestationalneoplasia, as mono therapy or in combination withothercytotoxic agents.Whileitisconsideredcardioprotective, datas regardingmethotrexate-inducedcardiomyopathy are rare. we report the case of a woman, initiallydiagnosedwithlow-risk trophoblasticgestationalneoplasia, whosuffered a myocardial infraction after the second course of methotrexate.

Case Presentation:A 47-year-old woman, with no othercomorbidities, wasinitiallydiagnosedwith a low-risktrophoblasticgestationalneoplasia, characterized by a Bhcg value of 12,022. Shewasundergoingmethotrexatemonotherapy for the condition. Following the second course of chemotherapy, the patient experiencedchest pain, and an electrocardiogramrevealed an elevation of the ST segment. As a result, thrombolytictreatmentwasadministered at H9 of pain onset.Due to the uncertaintysurrounding the relationbetween Methotrexate and the myocardialinfarction and consideringpotential interactions betweennonsteroidal anti-inflammatorydrugs (NSAIDs) and methotrexate, a decisionwas made to switch to Actinomycin D.The evolutionwas favorable, the patient isstillunder surveillance aftertwoyears of follow up.

Conclusion:This case report highlights a possible methotrexateinducedmyocardial infraction. Inthis setting our attitude was to switch for anotherdrug, whichwasverywelltolerated, withgood oncologicincome for our patient.