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Case Reports
. 2018 Sep-Oct;9(5):328-330.
doi: 10.4103/idoj.IDOJ_316_17.

Methotrexate Cutaneous Toxicity following a Single Dose of 10 mg in a Case of Chronic Plaque Psoriasis: A Possible Idiosyncratic Reaction

Aastha Gupta  1 , Kabir Sardana  1 , Minakshi Bhardwaj  2 , Ajeet Singh  1
Affiliations
Case Reports

Methotrexate Cutaneous Toxicity following a Single Dose of 10 mg in a Case of Chronic Plaque Psoriasis: A Possible Idiosyncratic Reaction

Aastha Gupta et al. Indian Dermatol Online J. 2018 Sep-Oct.

Abstract

Low-dose methotrexate is a well-tolerated and inexpensive systemic immunosuppressive agent used commonly in dermatology. However, several adverse events such as pancytopenia, pneumonitis, mucositis, and cutaneous ulcerations may develop during acute toxicity with dose-dependent or idiosyncratic mechanisms. Risk factors for methotrexate toxicity include advanced age, hypoalbuminemia, renal dysfunction, and concomitant drugs increasing the level of methotrexate in the body. We present a case of methotrexate toxicity presenting with classical features along with mucocutaneous side-effects, such as ulceration of psoriatic plaques and acral erythema, following a single dose of methotrexate.

Keywords: Cutaneous ulceration; low-dose methotrexate; methotrexate toxicity.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
Ulceration of the psoriatic plaques present over the neck
Figure 2
Figure 2
Painful erythematous macules with desquamation of the skin present on the palms and soles
Figure 3
Figure 3
Skin biopsy from ulcerated plaque showing ulcerated epidermis and parakeratotic keratin along with necrotic debris and fibrinosuppurative exudate and perivascular inflammatory infiltrate in dermis. (H and E, ×100)
See this image and copyright information in PMC

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