Acute Severe Methotrexate Toxicity in Patients with Psoriasis: A Case Series and Discussion

Abstract

Background: Methotrexate (MTX) is considered a relatively safe drug when prescribed at low-dose regimens not exceeding 25 mg/week. Severe acute toxicity is rare and presents with mucositis, cutaneous ulceration and pancytopenia. Most cases occur as the result of inadvertent overdosing due to erroneously taking the drug daily. However, concomitant factors such as older age, co-medication and renal failure may increase the drug's toxicity. Case Reports: We report four consecutive cases of acute MTX toxicity in patients with psoriasis vulgaris. In three patients, MTX was erroneously taken daily for 2-4 weeks. All three patients recovered following MTX withdrawal and intensive treatment. The fourth patient was taking 7.5 mg weekly MTX as prescribed, but had concomitant factors and died. Conclusion: Although low-dose MTX appears to be a safe medication, acute MTX toxicity can be a life-threatening emergency. Greater awareness of possible MTX toxicity is still needed for its prevention, early diagnosis and management.

Low-dose methotrexate-induced skin toxicity: Keratinocyte dystrophy as a histologic marker

“…These mucocutaneous manifestations are believed to be rare during low-dose methotrexate therapy, 3 as only a few anecdotal cases have been published. 4,5 However, their frequency may be underestimated, as their clinical features are ill described 6 and their histologic pattern reported to be nonspecific. 7,8 Thus, cases may be misdiagnosed by both dermatologists and pathologists.…”

Kutanöz Ülserler İle Seyreden Akut Metotreksat Toksi̇si̇tesi̇ / Acute Methotrexate Toxicity Presenting With Cutaneous Ulcerations

“…Herein, the approach to acute methotrexate toxicity will be discussed with reference to a case who is referred to our clinic. KEYWORDS: cutaneous ulceration, methotrexate, psoriasis Sayın Editör, Metotreksat, psoriaziste yaygın kullanılan ve haftalık 25 mg'yi aşmayan dozlarda göreceli olarak güvenli bir tedavidir (1). Metotreksatın iyi bilinen ve kronik kullanımı sırasında daha sık karşılaşılan dispepsi, hepatotoksisite ve miyelosupresyon gibi yan etkileri mevcuttur (2,3).…”

“…Bir çalışmada 1951 ile 1996 arasında sadece 66 hastanın bildirildiği belirtilmiştir (1). Kutanöz yan etkiler genellikle doz bağımlı olup, bazı risk faktörleri kolaylaştırıcı rol oynar (6).…”

“…En yaygın olan, doz ayarında yapılan hatalar ve ilacın yanlış kullanımıdır. Bunun dışında başta non-steroid anti-inflamatuar ilaçlar (NSAİİ) olmak üzere ek ilaç kullanımı, renal fonksiyonlarda yetersizlik ve eşlik eden diğer sistemik hastalıklar, ilacın farmakokinetiği, yüksek dozda alkol alımı, enfeksiyonlar ve ileri yaş diğer yaygın sebeplerdir (1 …”

The reaction of the skin and its appendages in rheumatoid arthritis patients using subcutaneous methotrexate: A description of three cases

“…Подавляя дегидрофолат редуктазу, МТ уменьшает клеточную проли-ферацию [1], с чем, очевидно, связаны такие неблагоприятные реакции (НР), как образо-вание язв слизистых оболочек у 17% и кож-ных эрозий у 5% онкологических больных, получавших очень большие дозы препарата [2]. Поэтому возникновение кожных язв считается признаком токсичности МТ [3], однако подобные НР, соголасно единичным наблюдениям, встречаются и при назначе-нии низких доз МТ [4,5]. При этом как кли-ническая картина реакций со стороны кож-ных покровов и придатков кожи [6], так и ги-стологические изменения не специфичны [7,8].…”