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From the Inland Pain Medicine in San Bernardino, and the Loma Linda University Medical Center Behavioral Medicine Center, Loma Linda, Calif (Dr P. Przekop), the University of Massachusetts Medical School (Drs Tulgan and Glantz) in Worcester, Mass, and the Loma Linda University Children's Hospital (Dr A. Przekop) in Loma Linda, Calif.

Address correspondence to Peter R. Przekop, DO, PhD, Inland Pain Medicine, 4130 N Hallmark Pkwy, Ste C, San Bernardino, CA 92407-1877. E-mail: pprzekop{at}earthlink.net

Recent advances in molecular biology have provided physicians with genetic testing strategies that can be used to predict adverse drug reactions (ADRs). Many ADRs can be linked to single-nucleotide polymorphisms in genes that control aspects of drug disposition. We report a case in which a standard dose of methotrexate resulted in life-threatening mucositis, neutropenia, and thrombocytopenia in a 61-year-old woman. The patient was found to have a genetic anomaly in an enzyme that plays a key role in folate metabolism. Methotrexate is known to deplete folate levels. As data accumulate and genetic testing strategies improve, it should be possible to predict ADRs in individual patients, thereby resulting in better patient care and a reduction in medical expenditures.