Suggested Guidelines for Patient Monitoring: Hepatic and Hematologic Toxicity Attributable to Systemic Dermatologic Drugs

Pancytopenia, mucositis, and hepatotoxicity after intralesional methotrexate injection in a patient treated with peritoneal dialysis

“…20 Methotrexateassociated bone marrow toxicity is also increased in the presence of hypoalbuminemia, folic acid deficiency, advanced age, alcohol ingestion, diabetes, obesity, drug interactions (e.g., with probenecid, penicillin, or trimethoprim-sulfamethoxazole), and macrocytosis. 10,21 Risk factors for hepatotoxicity include renal impairment, excessive alcohol ingestion, obesity, and diabetes mellitus. 21 Genetic variations may likewise affect methotrexate efficacy and toxicity.…”

“…10,21 Risk factors for hepatotoxicity include renal impairment, excessive alcohol ingestion, obesity, and diabetes mellitus. 21 Genetic variations may likewise affect methotrexate efficacy and toxicity. 8 The development of the toxicities seen in our patient was most likely the result of decreased clearance and accumulation of methotrexate due to renal impairment and overall poor removal of the drug by peritoneal dialysis.…”

A Woman with Chronic Subcutaneous Swelling of the Right Foot Associated with Sinus Tracts Discharging Yellow Grains

“…Fungal mycetomas are most frequently caused by members of the genera Madurella and Acemonium [3]. Of these, Madurella mycetomatis is the most prevalent causative mycetoma-inducing agent [4], [5]. The term mycetoma, coined by Vandyke Carter in 1860, suggests a fungal tumor [1], ; however, aerobic filamentous bacteria cause most cases worldwide (60% of cases) [3], [5].…”

“…However, there is some data to suggest an increasing number of eumycetomas in South America [3]. N. brasiliensis is the most common cause of actinomycetomas, particularly in the Americas [3], [4]. In Mexico, mycetomas are often identified among impoverished farm workers in rural arid settings in the mainland states of Guanajuato, Oaxaca, and Morelos [2].…”

“…Clinical suspicion of mycetomas is based on the clinical triad that includes the presence of slowly progressive painless subcutaneous swelling, sinus tract formation, and granular discharge [1]–[5] affecting the foot in particular (80% of cases) as well as other parts of the body including the hand, head, neck, and back [2]–[4]. Actinomycetomas tend to progress more rapidly than eumycetomas, producing more inflammatory and destructive lesions [3].…”