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Acute severe methotrexate toxicity in patients with psoriasis: a case series and discussion

Oriol Yélamos1, Alba Català, Eva Vilarrasa

  • 1Department of Dermatology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain.

Dermatology (Basel, Switzerland)
|November 18, 2014
PubMed
Abstract

Insights

Methotrexate (MTX) toxicity can be life-threatening, even at low doses. Accidental daily intake or underlying conditions increase risks, necessitating greater awareness for prevention and early management.

Area of Science:

  • Dermatology
  • Pharmacology
  • Toxicology

Background:

  • Methotrexate (MTX) is a widely used drug, generally safe at low doses (≤25 mg/week).
  • Severe acute toxicity is rare but can manifest as mucositis, cutaneous ulceration, and pancytopenia.
  • Risk factors include inadvertent daily dosing, older age, co-medication, and renal failure.

Observation:

  • Four cases of acute MTX toxicity in psoriasis vulgaris patients were analyzed.
  • Three patients experienced toxicity due to erroneously taking daily MTX for 2-4 weeks.
  • One patient on prescribed weekly MTX (7.5 mg) died due to concomitant factors.

Findings:

  • Acute MTX toxicity can occur even with standard low-dose regimens.
  • Erroneous daily dosing significantly elevates the risk of severe adverse events.
  • Concomitant factors like renal impairment exacerbate MTX toxicity.

Implications:

  • Increased clinical awareness of MTX toxicity is crucial for prevention.
  • Early diagnosis and prompt management are vital for improving patient outcomes.
  • MTX toxicity, though rare, represents a potentially life-threatening emergency requiring careful patient monitoring.

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