title: Cutaneous erosions: a herald for impending pancytopenia in methotrexate toxicity.
abstract: Psoriatic plaque erosion is a rare toxic side effect of low-dose methotrexate (LDMTX) that has been reported during the treatment of psoriasis and described as a herald for impending pancytopenia. Fatalities from this have rarely been reported. Even rarer is methotrexate (MTX)-induced erosions of clinically normal skin in patients without a history of psoriasis. We report 3 rare presentations of MTX-induced cutaneous erosions, 2 fatalities occurring with MTX-induced psoriatic plaque erosions, and the sixth reported case of MTX-induced erosions with no prior history of psoriasis. Each were elderly patients on proton pump inhibitors with a history of chronic non-steroidal anti-inflammatory drug (NSAID) use. They all presented with acute onset of erosions after a recent change in their MTX dose. Pancytopenia followed in each case. Physicians' awareness of the sequelae in MTX-induced cutaneous erosions is imperative so MTX can be discontinued and treatment instituted to prevent fatal bone marrow suppression.
authors.affiliation: The University of Arkansas for Medical Sciences.
authors.forename: Mallory B
authors.initials: MB
authors.lastname: Shiver
authors.forename: Lauren A
authors.initials: LA
authors.lastname: Hall
authors.forename: Kelly B
authors.initials: KB
authors.lastname: Conner
authors.forename: Grace E
authors.initials: GE
authors.lastname: Brown
authors.forename: Wang L
authors.initials: WL
authors.lastname: Cheung
authors.forename: Marla L
authors.initials: ML
authors.lastname: Wirges
mesh_terms: D000368:Aged; D018501:Antirheumatic Agents / Q000009:adverse effects; D001172:Arthritis, Rheumatoid / Q000188:drug therapy; D001706:Biopsy; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008297:Male; D008727:Methotrexate / Q000009:adverse effects*; D008875:Middle Aged; D010198:Pancytopenia / Q000139:chemically induced* / Q000175:diagnosis; D012867:Skin / Q000473:pathology; D012883:Skin Ulcer / Q000139:chemically induced* / Q000175:diagnosis
chemical_list: D018501:Antirheumatic Agents; D008727:Methotrexate