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

We describe the case of a 14-year-old girl with osteosarcoma who was treated with high-dose methotrexate (12 g/m²). Twenty-four hours after the infusion, her plasma methotrexate concentration was elevated at 937 μmol/L (normal < 10 µmol/L). She exhibited severe signs of methotrexate toxicity, including encephalopathy, acute liver failure (ALF), and acute kidney injury. In this case report, we highlight the severe and rare adverse effects secondary to methotrexate administration and the efficacity of molecular adsorbent recirculating system and continuous venovenous hemodiafiltration to recover from multiple organ failure.