[Methotrexate-induced skin detachment]

Area of Science:

• Oncology
• Dermatology
• Pharmacology

Background:

• High-dose methotrexate is used for high-grade lymphoma.
• Methotrexate commonly causes integument and mucosal toxicity.
• Cutaneous lesions of the skin proper are rare complications.

Observation:

• A male patient developed extensive skin erosions after a 5-gram intravenous dose of methotrexate.
• The patient also experienced renal, hepatic, and mucosal lesions, along with bone marrow aplasia.
• The mechanism of cutaneous necrosis is hypothesized to be direct epidermal toxicity from methotrexate.

Findings:

• The patient was treated with granulocyte-colony stimulating factor (G-CSF).
• Recovery from bone marrow aplasia occurred within 6 days without infectious complications.
• G-CSF may mitigate infection risk by shortening cytopenia duration.

Implications:

• This case highlights a rare but severe dermatological adverse effect of high-dose methotrexate.
• Early intervention with G-CSF can be crucial for managing methotrexate-induced complications.
• Understanding methotrexate toxicity mechanisms is vital for patient management in oncology.