<?xml version="1.0" encoding="ISO-8859-1"?><article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
<front>
<journal-meta>
<journal-id>0120-8705</journal-id>
<journal-title><![CDATA[CES Medicina]]></journal-title>
<abbrev-journal-title><![CDATA[CES Med.]]></abbrev-journal-title>
<issn>0120-8705</issn>
<publisher>
<publisher-name><![CDATA[Universidad CES]]></publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id>S0120-87052019000200119</article-id>
<article-id pub-id-type="doi">10.21615/cesmedicina.33.2.5</article-id>
<title-group>
<article-title xml:lang="es"><![CDATA[Pancitopenia inducida por bajas dosis de metotrexato]]></article-title>
<article-title xml:lang="en"><![CDATA[Low dose methotrexate induced pancytopenia]]></article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname><![CDATA[González-Martínez]]></surname>
<given-names><![CDATA[Daniel Felipe]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Cabrera-Velasco]]></surname>
<given-names><![CDATA[Carlos Ernesto]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Chilitio Zemanate]]></surname>
<given-names><![CDATA[Paulo Andrés]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Verhelst-Solano]]></surname>
<given-names><![CDATA[José Luis]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
</contrib-group>
<aff id="Af1">
<institution><![CDATA[,Universidad del Cauca Hospital Universitario San José ]]></institution>
<addr-line><![CDATA[ ]]></addr-line>
<country>Colombia</country>
</aff>
<aff id="Af2">
<institution><![CDATA[,Universidad del Quindío  ]]></institution>
<addr-line><![CDATA[ ]]></addr-line>
<country>Colombia</country>
</aff>
<aff id="Af3">
<institution><![CDATA[,Universidad del Cauca Hospital Universitario San José ]]></institution>
<addr-line><![CDATA[ ]]></addr-line>
<country>Colombia</country>
</aff>
<aff id="Af4">
<institution><![CDATA[,Universidad del Cauca  ]]></institution>
<addr-line><![CDATA[ ]]></addr-line>
<country>Colombia</country>
</aff>
<pub-date pub-type="pub">
<day>00</day>
<month>08</month>
<year>2019</year>
</pub-date>
<pub-date pub-type="epub">
<day>00</day>
<month>08</month>
<year>2019</year>
</pub-date>
<volume>33</volume>
<numero>2</numero>
<fpage>119</fpage>
<lpage>125</lpage>
<copyright-statement/>
<copyright-year/>
<self-uri xlink:href="http://www.scielo.org.co/scielo.php?script=sci_arttext&amp;pid=S0120-87052019000200119&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://www.scielo.org.co/scielo.php?script=sci_abstract&amp;pid=S0120-87052019000200119&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://www.scielo.org.co/scielo.php?script=sci_pdf&amp;pid=S0120-87052019000200119&amp;lng=en&amp;nrm=iso"></self-uri><abstract abstract-type="short" xml:lang="es"><p><![CDATA[Resumen El metotrexato es un agente que antagoniza el metabolismo del ácido fólico reduciendo los niveles de tetrahidrofolato en las células, inhibiendo su replicación y la síntesis de proteínas. Actualmente, se emplea en el tratamiento de diversas enfermedades malignas o inflamatorias. Tiene descritos numerosos efectos tóxicos, tanto a dosis altas en esquemas quimioterapéuticos como bajas de larga duración para inmunosupresión, los cuales incluyen compromiso hepático, neurológico, cutáneo, gastrointestinal y, con menor frecuencia, afección pulmonar y hematológica. Se reporta el caso de un paciente de edad avanzada quien se encontraba en tratamiento con metotrexato por más de cuatro años y acudió al servicio de urgencias con toxicidad severa resaltándose pancitopenia y concomitantemente choque séptico, quien, a pesar del manejo establecido, presentó evolución clínica desfavorable. Se resalta la importancia de tener en cuenta esta toxicidad dado su subregistro en Colombia y la repercusión que puede tener en un paciente incluso al establecer el manejo adecuado.]]></p></abstract>
<abstract abstract-type="short" xml:lang="en"><p><![CDATA[Abstract Methotrexate is an agent that antagonizes the metabolism of folic acid by reducing the levels of tetrahydrofolate in cells, which inhibits cellular replication and protein synthesis. It is currently used in the treatment of various malignancies and some inflammatory diseases such as rheumatoid arthritis. It has described numerous toxic effects both at high doses in chemotherapeutic schemes and long-term low doses for immunosuppression; these include renal, hepatic, neurological, cutaneous, gastrointestinal, and much less frequently pulmonary and hematological involvement. This article reports the case of an elderly patient who was in treatment with methotrexate for more than four years and went to the emergency department with severe toxicity highlighting pancytopenia and concomitant septic shock, whom despite the established management presented a poor response. The importance of taking into account this toxicity is highlighted given the underreporting in Colombia and the impact it can have on a patient even when establishing the appropriate management.]]></p></abstract>
<kwd-group>
<kwd lng="es"><![CDATA[Metotrexate]]></kwd>
<kwd lng="es"><![CDATA[Toxicidad]]></kwd>
<kwd lng="es"><![CDATA[Pancitopenia]]></kwd>
<kwd lng="en"><![CDATA[Methotrexate]]></kwd>
<kwd lng="en"><![CDATA[Toxcity]]></kwd>
<kwd lng="en"><![CDATA[Pancytopenia]]></kwd>
</kwd-group>
</article-meta>
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