Acute urticaria and hepatitis complicating high‐dose methotrexate therapy

Abstract

We report an unusual case of anaphylaxis and hepatitic dysfunction in a child with the administration of the twenty-third course of high-dose methotrexate. The latter had been used as an adjuvant to prevent pulmonary metastases and the prior 22 courses had been well tolerated. An attempt to reinstate methotrexate after the twenty-third course was again followed by a similar reaction.

Hypersensitivity reaction to high-dose methotrexate and successful rechallenge in a pediatric patient with osteosarcoma

“…The major side effects of high-dose methotrexate include mucositis, nephrotoxicity, hepatotoxicity, neurotoxicity, and pulmonary toxicity. Hypersensitivity reactions to high-dose methotrexate are uncommon, but have been reported [2][3][4][5][6][7][8][9][10][11][12][13][14]. Rechallenging pediatric oncology patients with high-dose methotrexate following hypersensitivity reactions has also been reported in the literature [4][5][6]10,13,14].…”

Anaphylaxis during the first course of high-dose methotrexate: a case report and literature review

“…Most of the reviewed cases occurred after repeated courses of MTX 6–15 . In contrast, only five patients (four from PubMed search plus ours) experienced anaphylactic reaction during the first MTX infusion, 2–5 as shown by our case and the literature search.…”

“…Most of the reviewed cases occurred after repeated courses of MTX. [6][7][8][9][10][11][12][13][14][15] In contrast, only five patients (four from PubMed search plus ours) experienced anaphylactic reaction during the first MTX infusion, 2-5 as shown by our case and the literature search. Davis et al 4 and Ozguven et al 5 reported anaphylaxis during the first course of high-dose MTX for osteosarcoma treatment.…”

Systemic near-fatal anaphylactic reaction after intrathecal methotrexate administration

“…He exhibited an acute hypersensitivity reaction to MTX given intrathecally rather than neurotoxicity. Hypersensitivity reactions have been reported in nearly 20 cases and include anaphylaxis, urticaria, angioedema, acute pneumonitis, cutaneous vasculitis, severe epidermal toxicity, hemolytic anemia, and hepatitis [2,14,15]. MTX given for psoriasis by either the oral or the parenteral route has resulted in isolated instances of urticarial reactions; none was severe [16,17].…”