DOI: http://dx.doi.org/10.18203/issn.2455-4529.IntJResDermatol20202671

Acute methotrexate toxicity with severe cutaneous ulcerations in a patient of chronic plaque psoriasis

Anil P. Gosavi, Rahul N. Jaiswal, Ravindranath B. Chavan, Sanjay N. Gaidhani

Abstract


Methotrexate continues to be one of the most widely used systemic immunosuppressive agents in chronic plaque psoriasis. In addition to the important well characterized adverse effects such as hepatotoxicity and myelosuppression, methotrexate may induce a number of mucocutaneous adverse events including methotrexate induced mucocutaneous ulcerations. We present a case of methotrexate induced severe cutaneous ulcerations in patient with chronic plaque psoriasis. 45 year old male known case of chronic plaque psoriasis on methotrexate therapy manifested as methotrexate toxicity leading to acute kidney injury with painful ulcerated plaques with active bleeding over previously psoriatic plaques over extremities and trunk with mucosal ulcerations responding effectively to leucovorin therapy. Dermatologists need to be alert to the possibility of cutaneous adverse events associated with methotrexate therapy especially ulcerations of psoriatic plaques. 


Keywords


Methotrexate Toxicity, Psoriasis, Leucovorin

Full Text:

PDF

References


Roenigk HH Jr., Auerbach R, Maibach HI, Weinstein GD. Methotrexate in psoriasis: Revised guidelines. J Am Acad Dermatol. 1988;19:145-56.

Czarnecka-Operacz M, Sadowska-Przytocka A. The possibilities and principles of methotrexate treatment of psoriasis – The updated knowledge. Postepy Dermatol Alergol. 2014;31:392-400.

Madke B, Singh AL. Acute methotrexate toxicity. Indian J Drugs Dermatol. 2015;1:46-9

Morgan SL, Baggott JE, Vaughn WH, Austin JS, Veitch TA, Lee JY, et al. Supplementation with folic acid during methotrexate therapy for rheumatoid arthritis. A double-blind, placebo-controlled trial. Ann Intern Med. 1994;121:833-41.

Olsen EA. The pharmacology of methotrexate. J Am Acad Dermatol. 1993;25:300-18.

Pearce HP, Wilson BB. Erosion of psoriatic plaques: An early sign of methotrexate toxicity. J Am Acad Dermatol. 1996;35:835-8.

Agarwal KK, Nath AK, Thappa DM. Methotrexate toxicity presenting as ulceration of psoriatic plaques: A report of two cases. Indian J Dermatol Venereol Leprol. 2008;74:481-4.