Acute methotrexate toxicity in patients with psoriasis: case series

Abstract

Methotrexate (MTX) is an antifolate metabolite that is used in the treatment of various autoimmune diseases, malignancies, and inflammatory disorders. In addition to the well-characterized side effects such as hepatotoxicity and myelosuppression, it can also rarely cause a variety of cutaneous manifestations due to acute toxicity. We are presenting case series of three patients of MTX toxicity. All three cases presented with acute ulceration and pain over the psoriatic plaques in addition to mucosal involvement. They were all given injectable folinic acid. Two out of the three patients died and one of them recovered. Although low-dose MTX appears to be relatively safe, acute MTX toxicity is a life-threatening emergency that can occur for which greater awareness of this condition is needed for its prevention, early diagnosis, and management.