Rescue therapy in methotrexate toxicity: case report

Shruthi Suresh, Namratha C. Manjunath, S. Kumar B C
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Abstract

Methotrexate (MTX) is widely used for the treatment of psoriasis. It has an antiproliferative action by inhibiting dihydrofolate reductase enzyme, therefore interferes with folic acid synthesis. MTX toxicity is rarely reported and the most common cause of it is accidental overdosage by the patient. This is a case report of a 51-year-old male, a known case of psoriasis, who presented with multiple erythematous tender plaques associated with burning sensation. He self-medicated with tablet MTX 5 mg daily for 10 days when the lesions got exacerbated and was found to be leucopenic. On skin biopsy, diagnosis of psoriasis with MTX induced epidermal necrolysis was established. Patient was treated with filgrastim 300 μg which was given subcutaneously 1 day apart. On follow up, lesions subsided and repeat counts were within normal limits. Patients should be explained about the selected treatment regime and discouraged from self-medicating.
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甲氨蝶呤毒性的抢救治疗:1例报告
甲氨蝶呤(MTX)被广泛用于治疗牛皮癣。它通过抑制二氢叶酸还原酶具有抗增殖作用,从而干扰叶酸的合成。MTX毒性很少报道,最常见的原因是患者意外过量服用。这是一例51岁男性牛皮癣患者的病例报告,他表现为多发红斑性压痛斑块并伴有烧灼感。当病变加重并发现白细胞减少时,他自行服用MTX片剂,每天5毫克,持续10天。皮肤活检,诊断银屑病与甲氨蝶呤诱导表皮坏死松解。患者给予非格拉西汀300 μg,每隔1天皮下给药。在随访中,病变消退,重复计数在正常范围内。应向患者解释所选择的治疗方案,不鼓励患者自行用药。
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