Mucocutaneous Ulcerations and Pancytopenia due to Methotrexate Overdose

Abstract

Methotrexate (MTX) is an antifolic drug used in the treatment of immune-mediated and neoplastic diseases. Initiation or dosage changes in MTX therapy can cause mucositis and bone marrow suppression. Skin lesions due to acute MTX toxicity are rare, but they serve as a herald for later-onset pancytopenia. Therefore, identification of those cutaneous lesions might help to initiate rescue strategies at an early stage. Here we describe a case with mucocutaneous ulcerations and pancytopenia due to overdosed MTX.

Medical system error causing methotrexate poisoning and delay in diagnosis: report of two cases

“…Because some drugs increase the half-life of methotrexate and the risk of toxicity like Indomethacin, ketoprofen, and naproxen (4). On the other hand, over 50% of MTX is bound to albumin and simultaneous ingestion of Non-steroid anti-rheumatic drugs, sulfonamides, retinoids, tetracyclines and salicylates increases the risk of methotrexate poisoning (5).…”

“…The liver also plays a role in the excretion of methotrexate (5). Use of folic acid or folinic acid is associated with a reduced incidence of aminotransferases elevation (9).…”

Dermatologic conditions in women receiving systemic cancer therapy

“…Erosive mucositis from MTX has been reported and may herald impending cytopenias, which may progress to fatal bone marrow failure (Demirkan et al, 2017, Knoll et al, 2016). Risk factors include dose escalations or treatment reinitiation, hypoalbuminemia, renal insufficiency, and use of certain drugs that displace MTX from plasma proteins or decrease its excretion, such as nonsteroidal anti-inflammatory drugs, sulfonamides, aspirin, or other antibiotics (Dervisoglou and Matiakis, 2015, Knoll et al, 2016). Folate or folinic acid substitution, as well as alkalinization of the urine, may hasten reversal of MTX-induced erosive mucositis (Dervisoglou and Matiakis, 2015, Knoll et al, 2016).…”

A Case Report on Methotrexate Overdose Induced Pancytopenia and Mucocutaneous Ulcerations

“…Daily accidental ingestion instead of weekly dose is a common cause of acute MTX toxicity. 4,5 Here we report a 55 years old female patient of psoriasis who had developed pancytopenia and mucositis after daily intake of MTX.…”