AUTHOR=Corbisier T. , Von Bueren André O. , Breunis W.B. , Grazioli S. 

TITLE=Role of molecular adsorbent recirculating system in methotrexate-induced acute liver failure: a case report and literature review

JOURNAL=Frontiers in Pediatrics

VOLUME=Volume 12 - 2024

YEAR=2024

URL=https://www.frontiersin.org/journals/pediatrics/articles/10.3389/fped.2024.1424919

DOI=10.3389/fped.2024.1424919

ISSN=2296-2360

ABSTRACT=We describe a 14-year-old girl with osteosarcoma who was treated with high dose methotrexate (12g/m2). Twenty-four hours after the infusion, her plasma methotrexate concentration was elevated at 937 μmol/L (normal < 10 µmol/). She exhibited severe signs of methotrexate toxicity, including encephalopathy, acute liver failure, and acute kidney injury. The patient underwent extracorporeal epuration treatment for methotrexate prior to regaining normalized renal and hepatic function.In this case report, we describe severe and rare adverse effects secondary to methotrexate administration and the efficacity of MARS (Molecular Adsorbent Recirculating System) and CVVHDF (Continuous Veno-Venous Hemodiafiltration) to recover from multiple organ failure.