An unusual case of acute methotrexate toxicity manifesting as ulcers on psoriatic plaques in an elderly male

Singh, GK; Chatterjee, Manas; Banerjee, Santanu; Kumar, Surg Lt Cdr Sourabh

doi:10.1016/j.mjafi.2012.11.006

Cited by 2 publications

(1 citation statement)

References 19 publications

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“…Type 1 are superficial painful erosions on preexisting psoriatic plaques, which can occur either shortly after initiation of treatment or with dose alteration; while type 2 ulcerations are rare, deeper ulcerations of nonpsoriatic skin or between the psoriatic plaques. 6 These ulcers generally heal completely within 7-10 days after discontinuation of the drug, 7,8 though some authors have reported them as an early marker of impending myelosuppression. 9 Hematologic toxicity affecting all cell lines (thrombocytopenia followed by leukopenia, anemia) generally appears within 1-3 weeks.…”

Section: Discussionmentioning

confidence: 99%

Methotrexate toxicity in psoriasis—A multicentric retrospective study

Singh¹,

Sapra²,

Bahuguna³

et al. 2022

Dermatologic Therapy

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Even today methotrexate (MTX) remains the backbone of psoriasis management in dermatological practice. The widespread usage as well as over the counter availability of drug in India has led to frequent incidents of overdosing, resulting in toxicity. However, there is a lack of large size, comprehensive study in literature emphasizing upon reasons behind drug toxicity, clinical manifestations, and various management aspects.The present study aims to evaluate risk factors, clinical features, and suggest best management protocol based upon our experience in the management of MTX toxicity.A multicentric, retrospective study was conducted including all cases of psoriasis who were treated for MTX toxicity in the last 5 years. Complete information including demographic details, drug history, detailed clinical evaluation, laboratory parameters, management protocol, and outcome were studied and analyzed. A total of 21 patients of psoriasis with MTX toxicity were included, of which 20 had mucocutaneous ulcerations and hematological abnormalities were found in 76% patients. All cases were treated with folinic acid and 85% patients recovered within 7-14 days. Three out of 21 patients succumbed to their illness despite the best possible treatment. Overdosing was found to be the most common cause (66%) of drug toxicity, either inadvertent or due to self-medication. Patients must be counseled regarding course of the disease, drug regimen, and dreaded side effects prior to initiating the drug. In case the symptoms of toxicity appear, a prompt medical advice must be sought.

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Section: Discussionmentioning

confidence: 99%

Methotrexate toxicity in psoriasis—A multicentric retrospective study

Singh¹,

Sapra²,

Bahuguna³

et al. 2022

Dermatologic Therapy

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Methotrexate

2015

Reactions Weekly

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An 83-year-old man developed acute drug toxicity, disorientation and ulcers on psoriatic plaques following therapy with methotrexate.The man had a 20 years history of psoriasis vulgaris. He presented to a dermatological centre with sudden onset inability to get up from bed, development of ulcers on his psoriatic plaques and disorientation after the injection of methotrexate. He had been receiving the injection of methotrexate for 3 days at a dose of 15mg. It was noted that he received methotrexate tablets in the past for fast relief. On presentation, he was febrile and had tachycardia. He showed marked pallor, glossitis and mild pedal oedema. He presented marked weakness of all 4 limbs with grade III power in the upper limbs and grade II in lower limbs. His dermatological evaluation showed ulcers on the psoriatic plaques. His laboratory tests revealed the following haemoglobin 5.2 g/dL, mean corpuscular volume 96fL, WBC 4600 /µL, RBC 4.45 lac/µL, platelet count 3.5 lac/µL, blood urea nitrogen 102 mg/dL, total bilirubin 2.4 mg/dL, creatinine 2.1 mg/dL, direct bilirubin 1.2 mg/dL, SGPT 96 IU/L, SGOT 110 IU/L and alkaline phosphatase 113 IU/L. A diagnosis of acute methotrexate toxicity was made.The man was treated with leucovorin calcium and packed RBC transfusion. He was hydrated with normal saline and received broad spectrum antibiotic. He received compresses of potassium permanganate followed by application of framycetin for skin care. Subsequently, his fever resolved, he was well oriented on the next day. His ulcers resolved over a period of 3 days, and he became ambulatory in 4 days. After 7 days, his haemoglobin was 9.8 g/dL. His other laboratory values normalised. On the same day, he was discharged from the hospital on oral haematinics and supportive topical therapy.Author comment: "Our patient used injectable methotrexate for fast relief of psoriasis without realising its potential adverse effects." "He was diagnosed as a case of acute methotrexate toxicity."

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An unusual case of acute methotrexate toxicity manifesting as ulcers on psoriatic plaques in an elderly male

Cited by 2 publications

References 19 publications

Methotrexate toxicity in psoriasis—A multicentric retrospective study

Methotrexate toxicity in psoriasis—A multicentric retrospective study

Methotrexate

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