Methotrexate-induced toxic epidermal necrolysis in a patient with psoriasis

Primka, Edward J.; Camisa, Charles

doi:10.1016/s0190-9622(97)70029-x

Cited by 58 publications

(31 citation statements)

References 9 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…[5][6][7][8] Other risk factors include older age, renal insufficiency, folic acid deficiency, infection, and other medications, such as penicillin, cyclosporine, salicylates, phenytoin, trimethoprim-sulfamethoxazole, and dipyridamole. 6,7,10 The typical histopathology associated with cutaneous methotrexate toxicity, namely keratinocyte swelling, dyskeratosis, and epidermal necrolysis, supports the clinical findings of a direct toxic effect by methotrexate on the hyperproliferative plaques of psoriasis. 5 Typically, these changes are associated with an absent or only slight perivascular lymphocytic infiltrate without eosinophils.…”

Section: Discussionsupporting

confidence: 53%

Acute Mucocutaneous Methotrexate Toxicity Associated With Interface Dermatitis and Numerous Eosinophils

Ferguson¹,

Asarch²,

VanBeek³

et al. 2013

The American Journal of Dermatopathology

View full text Add to dashboard Cite

Acute mucocutaneous methotrexate toxicity is not classically associated with prominent tissue eosinophilia. We present a case of acute methotrexate toxicity associated with pancytopenia and mucocutaneous erosion with interface dermatitis and numerous eosinophils. A 79-year-old male, with a history of psoriasis vulgaris on methotrexate therapy, presented with blisters of the oral mucosa, groin, sacrum, and extremities after daily consumption of methotrexate. Examination revealed blisters and erosions localized to psoriatic plaques, the perineum, and the oral mucosa. Laboratory evaluation demonstrated pancytopenia, megaloblastic anemia, and elevated liver function tests. A skin biopsy of an eroded plaque revealed psoriasiform epidermal hyperplasia with epidermal erosion, parakeratosis, and loss of the granular cell layer. There was an underlying band-like lymphoid infiltrate with interface dermatitis, dyskeratotic keratinocytes, and numerous eosinophils. Direct immunofluorescence studies were negative for the deposition of immunoreactants. Methotrexate was held, and the patient received leucovorin resulting in improvement of blood counts and cutaneous lesions. The histopathologic changes associated with acute mucocutaneous toxicity have been described as pauci-inflammatory erosions associated with dyskeratotic keratinocytes to interface dermatitis with necrotic keratinocytes and occasionally associated eosinophils. Although these changes are most often superimposed on psoriatic plaques, they have been reported to occur on normal skin. Therefore, the differential diagnosis may include lichen planus, a lichenoid drug eruption, or a fixed drug eruption, and given the presence of mucosal ulceration, incipient pemphigus vulgaris or paraneoplastic pemphigus vulgaris. This case illustrates that acute mucocutaneous methotrexate toxicity may be associated with both interface dermatitis and numerous eosinophils.

show abstract

Section: Discussionsupporting

confidence: 53%

Acute Mucocutaneous Methotrexate Toxicity Associated With Interface Dermatitis and Numerous Eosinophils

Ferguson¹,

Asarch²,

VanBeek³

et al. 2013

The American Journal of Dermatopathology

View full text Add to dashboard Cite

show abstract

“…The most common minor adverse events associated with lowdose MTX use are stomatitis, headaches, nausea, fatigue, and anorexia (5,6). While hepatotoxicity has historically been the most feared side effect, pancytopenia is now emphasized as the most serious adverse event.…”

Section: Discussionmentioning

confidence: 99%

“…Age >55, folate deficiency, low serum albumin level, and drug-drug interactions are also common risk factors (Table 2) (5,7,8).…”

Section: Discussionmentioning

confidence: 99%

“…NSAIDs (drug retention), aspirin sulfonamides, penicillin, and colchicines (decreases MTX clearance), barbiturates, nitrofurantoin (impair folate absorption), trimethoprimsulfamethoxazole, triamterene, pyrimethamine, ethanol (inhibit the enzyme dihydrofolate reductase) phenytoin, probenecid, salicylates, sulfonamides, tetracycline, chloramphenicol, sulfonylureas (displace MTX from albumin), PPIs (the renal excretion of MTX) are the main accused drugs (4,5,7,9). …”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

A case of Severe Low-dose Methotrexate-induced Toxicity

Demir¹,

Tezcan²,

Türkoğlu³

et al. 2016

Haseki

View full text Add to dashboard Cite

“…One of the two mechanism is direct endothelial toxicity and the other is hypersensitivity reaction. 7,8 In PROPEL study,the most common side effects were mucositis, nausea, thrombocytopenia, and fatigue. The most common grade 3 or 4 side effects were thrombocytopenia, mucositis, neutropenia, and anemia.…”

Section: International Journal Of Hematology and Oncologymentioning

confidence: 99%

Pralatrexate-Induced Toxic Epidermal Necrolysis

Demırsoy¹

2017

UHOD

View full text Add to dashboard Cite

Methotrexate-induced toxic epidermal necrolysis in a patient with psoriasis

Cited by 58 publications

References 9 publications

Acute Mucocutaneous Methotrexate Toxicity Associated With Interface Dermatitis and Numerous Eosinophils

Acute Mucocutaneous Methotrexate Toxicity Associated With Interface Dermatitis and Numerous Eosinophils

A case of Severe Low-dose Methotrexate-induced Toxicity

Pralatrexate-Induced Toxic Epidermal Necrolysis

Contact Info

Product

Resources

About