A Case of Cutaneous Side Effect of Methotrexate Mimicking Behçet's Disease

Abstract

Methotrexate (MTX) is an antimetabolite which interferes with DNA synthesis, and it is used for the treatment of moderate to severe psoriasis, atopic dermatitis and a wide variety of cutaneous diseases. Although many adverse effects of MTX, including cutaneous ulcerations, have been documented, multifocal mucosal ulceration mimicking Behçet's disease has not been reported. In our case, a 63-year-old female presented with oral, vaginal ulcer and multiple purpuric patches on both legs. Considering patient's clinical course and histopathologic findings, we presumed that these reactions may be the side effect of MTX administered for treatment of necrotizing scleritis. Herein we report the cutaneous side effect of MTX that manifested clinically like Behçet's disease.

Combined treatment with vitamin C and methotrexate inhibits triple-negative breast cancer cell growth by increasing H2O2 accumulation and activating caspase-3 and p38 pathways

“…Currently, combined chemotherapy with MTX and other anticancer drugs, such as mitomycin C, cyclophosphamide and 5-fluorouracil, is used to treat breast cancer (18)(19)(20). However, serious side-effects of these chemicals have been reported (21)(22)(23)(24)(25). Therefore, drugs that can promote the anticancer activities of MTX with reduced side-effects are urgently needed.…”

Oral ulceration due to methotrexate treatment: A report of 3 cases and literature review

“…The third one includes effects of long-term treatment in diseases such as liver or cardiovascular diseases, caused mainly by hyper-homocysteinaemia. General adverse effects include gastrointestinal toxicity 3,4,8,10 (nausea 1,7,9 , vomiting 1 , abdominal discomfort, anorexia, dyspepsia, diarrhea 7 ), hepatotoxicity 1,3,4,10 (hepatitis 2 , fibrosis 6,8 , cirrhosis 8 ), myelosuppression [1][2][3][4][5]8,10 , (leukocy-topenia, thrombocytopenia, pancytopenia), hyperhomocysteinemia 4,10 , hypersensitivity causing pulmonary toxicity 3,4,10 , renal Interacting drugs can also affect serum MTX levels, despite a correctly administered low-dose MTX. Drugs that interact with renal and hepatic function e.g.…”

“…Methotrexate (MTX) is an antimetabolite, acting as a DHP reductase inhibitor, resulting in blocking intracellular DNA synthesis 1,2 . It is used for the treatment of both benign conditions (rheumatoid arthritis 1,[3][4][5][6][7][8][9][10][11] , psoriasis 1,2,3,5,8,12 , atopic dermatitis 2 , psoriatic arthritis 2,12 , collagen vascular disease 2 ) and malignancies (leukemia 3 , non-Hodgkin's lymphoma 5,9 , cutaneous T cell lymphoma 2 , choriocarcinoma 3 ). MTX was approved as an antirheumatic drug in 1999 4,10 .…”

“…Adverse effects to MTX include gastrointestinal toxicity 3,4,6,8,10 , hepatotoxicity 1,5,6,7,10 , myelosuppresion [1][2][3][4][5]10,12 and oral manifestations (oral ulceration and oral mucositis) 5,10,12,13 . Severe oral manifestations are common in high-dose MTX therapy, especially for the treatment of malignancies.…”

Methotrexate a Double Edged Sword – Effect of Methotrexate in patients of Psoriasis due to Medication Errors

“…This is seen with almost all the cases described above. 6 A study by Moore TJ et al had showed that total of 106 cases of reported medication errors associated with methotrexate were identified over a period of 4 years 7 . The medication errors resulted in 25 deaths (24%) and 48 other serious outcomes (45%).…”