title: Acute methotrexate toxicity seen as plaque psoriasis ulceration and necrosis: A diagnostic clue.
abstract: In addition to the well-known signs of methotrexate toxicity, rare cutaneous side effects have been described. These cutaneous signs may provide a diagnostic clue into the diagnosis of toxicity as well as facilitate early and aggressive therapy. We describe the case of a 37-year-old male, with a diagnosis of psoriasis, who developed characteristic signs and symptoms of acute methotrexate toxicity after receiving an unknown amount of intravenous methotrexate. The patient experienced a distinct change in the morphology of his existing psoriatic plaques, which became ulcerated and necrotic in the week following the methotrexate injection. Shortly after the development of cutaneous erosions, the patient developed pancytopenia, which ultimately led to his death. Ulceration and necrosis of cutaneous psoriasis plaques may serve as a herald for the impending development of life-threatening pancytopenia in patients with acute methotrexate toxicity.
authors.affiliation: Westlake Dermatology, Austin, Texas, USA.
authors.forename: Julie L
authors.initials: JL
authors.lastname: Fridlington
authors.forename: Julia W
authors.initials: JW
authors.lastname: Tripple
authors.forename: Jason S
authors.initials: JS
authors.lastname: Reichenberg
authors.forename: Clifton S
authors.initials: CS
authors.lastname: Hall
authors.forename: Dayna G
authors.initials: DG
authors.lastname: Diven
mesh_terms: D058186:Acute Kidney Injury / Q000139:chemically induced; D000328:Adult; D017963:Azithromycin / Q000627:therapeutic use; D001706:Biopsy; D017809:Fatal Outcome; D000069585:Filgrastim; D016179:Granulocyte Colony-Stimulating Factor / Q000627:therapeutic use; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects* / Q000627:therapeutic use; D002955:Leucovorin / Q000627:therapeutic use; D008297:Male; D008727:Methotrexate / Q000009:adverse effects* / Q000627:therapeutic use; D052016:Mucositis / Q000139:chemically induced; D009336:Necrosis; D010198:Pancytopenia / Q000139:chemically induced; D010949:Plasma; D011565:Psoriasis / Q000188:drug therapy / Q000473:pathology*; D011994:Recombinant Proteins / Q000627:therapeutic use; D012651:Self Medication; D012883:Skin Ulcer / Q000139:chemically induced* / Q000209:etiology; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000627:therapeutic use
chemical_list: D007166:Immunosuppressive Agents; D011994:Recombinant Proteins; D016179:Granulocyte Colony-Stimulating Factor; D015662:Trimethoprim, Sulfamethoxazole Drug Combination; D017963:Azithromycin; D000069585:Filgrastim; D002955:Leucovorin; D008727:Methotrexate