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. 2020 Jan;15(1):NP14-NP21.
doi: 10.1177/1558944719837657. Epub 2019 Sep 22.

Extremity Findings of Methotrexate Embryopathy

Esperanza Mantilla-Rivas  1 , Ashleigh Brennan, Agnes Goldrich  2 , Justin R Bryant  1 , Albert K Oh  1 , Gary F Rogers  1
Affiliations

Extremity Findings of Methotrexate Embryopathy

Esperanza Mantilla-Rivas et al. Hand (N Y). 2020 Jan.

Abstract

Background: Methotrexate (MTX) is widely used as an immunosuppressant, chemotherapeutic, and abortifacient agent. It is also a potent teratogen, and intentional or unintentional exposure during pregnancy is associated with heterogeneous birth anomalies. Methods: We retrospectively reviewed a cohort of patients who presented to our clinic with limb anomalies in the setting of MTX embryopathy. Results: In our case series, we describe 7 cases of patients who had limb anomalies with heterogeneous functionality, from severely debilitating to completely asymptomatic. Most of the upper extremity anomalies in our group were managed conservatively. Conclusions: Methotrexate embryopathy is a rare but clinically important entity with phenotypic and functional variability. This series underscores the need for proper counseling of patients and raises concern regarding using this medication for the purpose of abortion.

Keywords: embryopathy; extremity; methotrexate; oligodactyly.

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Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Case 1. Bilateral hands with hypoplasia of the index, long, and small finger medial phalanx, and the absence of left thumb distal phalanx.
Figure 2.
Figure 2.
Case 2. (a) Clinical and (b) radiograph finding: shortened humerii, radioulnar synostosis with fixed elbow contractures, and small finger clinodactyly.
Figure 3.
Figure 3.
Case 3. Right hand and foot radiographs. (a) Absence of thumb, small finger clinodactyly and (b) syndactyly of the right foot.
Figure 4.
Figure 4.
Case 4. (a) Clinical and (b) radiograph findings: right foot oligodactyly with a narrow forefoot.
See this image and copyright information in PMC

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