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Current Drug Safety

Editor-in-Chief

ISSN (Print): 1574-8863
ISSN (Online): 2212-3911

Case Report

Severe Pancytopenia Following Single Dose Methotrexate In Psoriasis: A Rare And Potentially Lethal Manifestation

Author(s): Ajeet Singh*, Ritul Choudhary, Namrata Chhabra, Satyaki Ganguly and Vinay Rathore

Volume 16 , Issue 1 , 2021

Published on: 26 October, 2020

Page: [110 - 113] Pages: 4

DOI: 10.2174/1574886315666201026125149

Price: $65

Abstract

Methotrexate is an anti-metabolite, anti-cancer drug frequently used in the treatment of extensive chronic plaque psoriasis. Psoriatic plaque erosion is a rare toxic side effect of single-dose methotrexate and is described as a sign of impending pancytopenia. Here, we report a case of a 48- year-old male presented with multiple oral and genital erosions, accompanied by fissuring over palm and soles for 5 days. His laboratory tests revealed severe pancytopenia and nephropathy. He had a history of chronic plaque psoriasis for which he took a single dose of 15 mg methotrexate. During the hospital stay, the patient needed folate antagonist, granulocyte colony-stimulating factor (G-CSF), intravenous fluids, blood transfusions, and platelet transfusions. He recovered within 12 days of admission.

Keywords: Psoriatic, acute methotrexate toxicity, pancytopenia, nephropathy, blood transfusions, granulocyte colony stimulating factor.

Graphical Abstract
[2]
Shaikh N, Sardar M, Raj R, Jariwala P. A rapidly fatal case of low-dose methotrexate toxicity. Case Rep Med 2018; 2018: 9056086.
[http://dx.doi.org/10.1155/2018/9056086] [PMID: 30008749]
[3]
Naranjo CA, Busto U, Sellers EM, et al. A method for estimating the probability of adverse drug reactions. Clin Pharmacol Ther 1981; 30(2): 239-45.
[http://dx.doi.org/10.1038/clpt.1981.154] [PMID: 7249508]
[4]
Chan ESL, Cronstein BN. Methotrexate- how does it really work? Nat Rev Rheumatol 2010; 6(3): 175-8.
[http://dx.doi.org/10.1038/nrrheum.2010.5] [PMID: 20197777]
[5]
Paxton JW. Protein binding of methotrexate in sera from normal human beings: Effect of drug concentration, pH, temperature, and storage. J Pharmacol Methods 1981; 5(3): 203-13.
[http://dx.doi.org/10.1016/0160-5402(81)90088-7] [PMID: 7311560]
[6]
Gaies E, Jebabli N, Trabelsi S, et al. Methotrexate side effects: review article. J Drug Metab Toxicol 2012; 3: 125.
[http://dx.doi.org/10.4172/2157-7609.1000125]
[7]
Dogra S, Mahajan R. Systemic methotrexate therapy for psoriasis: Past, present and future. Clin Exp Dermatol 2013; 38(6): 573-88.
[http://dx.doi.org/10.1111/ced.12062] [PMID: 23837932]
[8]
Sawada Y, Kawakami C, Nakamura M, Tokura Y, Yoshiki R. Toxic epidermal necrosis-like dermatosis induced by the first course of methotrexate. Eur J Dermatol 2009; 19(4): 397-8.
[http://dx.doi.org/10.1684/ejd.2009.0690] [PMID: 19467968]
[9]
Lawrence CM, Dahl MG. Two patterns of skin ulceration induced by methotrexate in patients with psoriasis. J Am Acad Dermatol 1984; 11(6): 1059-65.
[http://dx.doi.org/10.1016/S0190-9622(84)70259-3] [PMID: 6512051]
[10]
Shiver MB, Hall LA, Conner KB, Brown GE, Cheung WL, Wirges ML. Cutaneous erosions: A herald for impending pancytopenia in methotrexate toxicity. Dermatology Online J 2014; 20(7): 13030.
[11]
Lim AY, Gaffney K, Scott DG. Methotrexate-induced pancytopenia: Serious and under-reported? Our experience of 25 cases in 5 years. Rheumatology (Oxford) 2005; 44(8): 1051-5.
[http://dx.doi.org/10.1093/rheumatology/keh685] [PMID: 15901903]
[12]
Delyon J, Ortonne N, Benayoun E, et al. Low-dose methotrexate-induced skin toxicity: Keratinocyte dystrophy as a histologic marker. J Am Acad Dermatol 2015; 73(3): 484-90.
[http://dx.doi.org/10.1016/j.jaad.2015.06.015] [PMID: 26190242]
[13]
Kivity S, Zafrir Y, Loebstein R, Pauzner R, Mouallem M, Mayan H. Clinical characteristics and risk factors for low dose methotrexate toxicity: A cohort of 28 patients. Autoimmun Rev 2014; 13(11): 1109-13.
[http://dx.doi.org/10.1016/j.autrev.2014.08.027] [PMID: 25172240]
[14]
Gupta A, Sardana K, Bhardwaj M, Singh A. Methotrexate cutaneous toxicity following a single dose of 10 mg in a case of chronic plaque psoriasis: A possible idiosyncratic reaction. Indian Dermatol Online J 2018; 9(5): 328-30.
[PMID: 30258802]
[15]
Hsu MC, Chen CC. Low-dose methotrexate-induced ulcerated psoriatic plaques: A rare case. JAAD Case Rep 2015; 1(5): 264-6.
[http://dx.doi.org/10.1016/j.jdcr.2015.06.003] [PMID: 27051748]
[16]
Agarwal V, Chauhan S, Singh R, et al. Pancytopenia with the first dose of methotrexate in a patient with psoriatic arthritis. J Indian Rheumatol Assoc 2005; 13: 60-1.
[17]
Jariwala P, Kumar V, Kothari K, Thakkar S, Umrigar DD. Acute methotrexate toxicity: A fatal condition in two cases of psoriasis. Case Rep Dermatol Med 2014; 2014: 946716.
[http://dx.doi.org/10.1155/2014/946716] [PMID: 25276442]
[18]
Fridlington JL, Tripple JW, Reichenberg JS, Hall CS, Diven DG. Acute methotrexate toxicity seen as plaque psoriasis ulceration and necrosis: A diagnostic clue. Dermatol Online J 2011; 17(11): 2.
[PMID: 22136858]

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