title: Acute methotrexate toxicity: a fatal condition in two cases of psoriasis.
abstract: We describe two fatal cases of low dose methotrexate (MTX) toxicity in patients with psoriasis, emphasizing the factors that exacerbate MTX toxicity. The first patient was a 50-year-old male of psoriasis on intermittent treatment with MTX. After a treatment-free period of six months, he had self-medication of MTX along with analgesic for joint pain for one week which followed ulceration of the lesions, bone marrow suppression, and eventually death. The second patient was a 37-year-old male of psoriasis, who has taken MTX one week earlier without prior investigations. He had painful ulcerated skin lesions and bone marrow suppression. On investigations, he showed high creatinine level and atrophied, nonfunctioning right kidney on ultrasonography. In spite of dialysis, he succumbed to death. MTX is safe and effective if monitored properly, but inadvertent use may lead to even death also. Prior workup and proper counseling regarding the drug interactions as well as self-medication should be enforced.
authors.affiliation: Department of Skin & VD, Government Medical College & New Civil Hospital, Surat, Gujarat 395001, India.
authors.forename: Pankti
authors.initials: P
authors.lastname: Jariwala
authors.affiliation: Department of Skin & VD, Government Medical College & New Civil Hospital, Surat, Gujarat 395001, India.
authors.forename: Vinay
authors.initials: V
authors.lastname: Kumar
authors.affiliation: Department of Skin & VD, Government Medical College & New Civil Hospital, Surat, Gujarat 395001, India.
authors.forename: Khyati
authors.initials: K
authors.lastname: Kothari
authors.affiliation: Department of Skin & VD, GMERS Medical College & General Hospital, Gotri 202, Wings Ville 41, Arunoday Society, Alkapuri, Vadodara, Gujarat 390001, India.
authors.forename: Sejal
authors.initials: S
authors.lastname: Thakkar
authors.affiliation: Department of Skin & VD, Government Medical College & New Civil Hospital, Surat, Gujarat 395001, India.
authors.forename: Dipak Dayabhai
authors.initials: DD
authors.lastname: Umrigar