Unmasking the Masked: A Case Report of Atypical Methotrexate Toxicity Leading to Severe Bone Marrow Suppression

Methotrexate (MTX), a cornerstone in the management of rheumatic diseases, can induce severe adverse effects if not monitored meticulously. This report details a rare case of MTX-induced severe bone marrow suppression in a 65-year-old female, highlighting the critical importance of dosing accuracy, especially in the elderly. The patient, diagnosed with rheumatoid arthritis, experienced an acute episode of toxicity due to a dosing error. This case underscores the necessity for stringent monitoring and patient education to prevent similar incidents.