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


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. 


Methotrexate Toxicity, Psoriasis, Leucovorin

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