Sunburn Recall Reaction and Mucositis Secondary to Methotrexate Toxicity

Area of Science:

• Dermatology
• Rheumatology
• Hepatology

Background:

• A 59-year-old Native American female with a history of vitiligo and rheumatoid arthritis (RA) was treated with methotrexate (MTX), adalimumab, prednisone, and naproxen sodium.
• The patient had a 5-year history of RA, indicating a chronic autoimmune condition requiring ongoing management.

Observation:

• The patient presented with a 4-day history of malaise, abdominal pain, nausea, jaundice, and a distinctive rash.
• Physical examination revealed scleral icterus, diffuse jaundice, hemorrhagic crusting of the lips, and erythematous patches on the neck and back.
• Additional findings included papules on the extremities and petechiae on the trunk and upper extremities.

Findings:

• The clinical presentation suggests a potential drug-induced reaction or a complication of her autoimmune disease.
• The combination of jaundice and a widespread rash in a patient on multiple immunosuppressants warrants thorough investigation.

Implications:

• This case underscores the need for vigilant monitoring of patients with rheumatoid arthritis on complex medication regimens.
• Early recognition of adverse drug reactions is crucial for timely intervention and management of potentially serious conditions like drug-induced liver injury or severe cutaneous reactions.