title: Methotrexate-induced panniculitis in a patient with rheumatoid arthritis.
abstract: Methotrexate-induced accelerated nodulosis (MIAN) is not an uncommon adverse effect associated with the use of the methotrexate in rheumatoid arthritis. Limited case reports describe panniculitis as a pathological finding in this setting. A 31-year-old female with seropositive rheumatoid arthritis on methotrexate therapy presented with a 2-week history of sudden onset of painful infiltrated subcutaneous nodules on both forearms. Based on clinical and histological findings, a diagnosis of methotrexate-induced panniculitis was made. The majority of MIAN case reports that we reviewed showed characteristic pathological findings of classic rheumatoid nodules; few reported panniculitis as a finding. This case illustrates the importance of recognizing this phenomenon as methotrexate-induced panniculitis should be considered in the differential diagnosis of any patient receiving methotrexate presenting with a recent history of accelerated nodulosis. Discontinuation of methotrexate remains controversial.
authors.affiliation: Dermatology Department, Sheikh Khalifa Medical City (SKMC), Abu Dhabi, UAE.
authors.forename: Raghda
authors.initials: R
authors.lastname: Al Maashari
authors.affiliation: Pathology and Laboratory Medicine Department, Sheikh Khalifa Medical City (SKMC), Abu Dhabi, UAE.
authors.forename: Mowafak M
authors.initials: MM
authors.lastname: Hamodat
mesh_terms: D000328:Adult; D018501:Antirheumatic Agents / Q000009:adverse effects*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D005260:Female; D006801:Humans; D008727:Methotrexate / Q000009:adverse effects*; D015434:Panniculitis / Q000139:chemically induced* / Q000473:pathology
chemical_list: D018501:Antirheumatic Agents; D008727:Methotrexate