Clinical toxicology (Philadelphia, Pa.) · 2025
Methotrexate-induced epidermal necrosis.
Клинический случайСтатьяНазвание и аннотация: Перевод в очереди
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Kennedy Christopher, Thompson John A
Аннотация
INTRODUCTION: Methotrexate-induced epidermal necrosis is a rare, potentially fatal mucocutaneous reaction that clinically mimics Stevens-Johnson syndrome/toxic epidermal necrolysis. Early clinical manifestations include leukopenia, thrombocytopenia, mucositis and skin erosions. Risk factors for methotrexate-induced epidermal necrosis include age greater than 60 years, chronic kidney disease, and high initial dose of methotrexate (>10 mg/weekly) without folic acid supplementation.
CASE SUMMARY: A 63-year-old female with a history of psoriasis started taking oral methotrexate 10 mg weekly without folic acid supplementation and developed a desquamating rash covering more than 70% of her body. Her rash developed within two weeks of starting methotrexate. She received treatment with calcium folinate and made a full recovery.
IMAGES: Clinical images obtained on hospital day two show diffuse skin erosions and necrosis.
CONCLUSION: Methotrexate-induced epidermal necrosis is an uncommon, potentially fatal, adverse reaction to methotrexate. Early diagnosis of methotrexate-induced epidermal necrosis can prompt early intervention with calcium folinate and hopefully mitigate potentially fatal outcomes associated with methotrexate toxicity.
CASE SUMMARY: A 63-year-old female with a history of psoriasis started taking oral methotrexate 10 mg weekly without folic acid supplementation and developed a desquamating rash covering more than 70% of her body. Her rash developed within two weeks of starting methotrexate. She received treatment with calcium folinate and made a full recovery.
IMAGES: Clinical images obtained on hospital day two show diffuse skin erosions and necrosis.
CONCLUSION: Methotrexate-induced epidermal necrosis is an uncommon, potentially fatal, adverse reaction to methotrexate. Early diagnosis of methotrexate-induced epidermal necrosis can prompt early intervention with calcium folinate and hopefully mitigate potentially fatal outcomes associated with methotrexate toxicity.