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High-dose methotrexate-induced epidermal necrosis in two pediatric patients
Manisha Ravi1, Alyson Ridpath2, Anthony N Audino3
1The Ohio State University College of Medicine, Columbus, OH, USA.
Pediatric Dermatology
|April 8, 2021
Summary
Methotrexate-induced epidermal necrosis (MEN) is a rare but serious side effect of chemotherapy. Prompt treatment with corticosteroids and folinic acid rescue enabled pediatric patients to continue their essential cancer treatment.
Area of Science:
- Oncology
- Dermatology
- Pediatrics
Background:
- High-dose methotrexate is a critical chemotherapy agent for pre-B-cell acute lymphocytic leukemia.
- Methotrexate-induced epidermal necrosis (MEN) is a rare, potentially fatal adverse effect.
- Pediatric oncology requires careful management of chemotherapy side effects.
Observation:
- Two pediatric patients (5-year-old girl, 3-year-old boy) developed MEN during high-dose methotrexate therapy.
- Clinical presentation included erythematous lesions progressing to skin erosions.
- MEN occurred despite standard pre-medication protocols.
Findings:
- Systemic corticosteroids were administered as pre-medication.
- Folinic acid rescue was provided post-methotrexate infusion.
- Both interventions were crucial for managing MEN.
Implications:
- Effective management strategies for MEN are vital in pediatric oncology.
- Corticosteroids and folinic acid rescue can mitigate severe methotrexate toxicity.
- This case series highlights the importance of vigilant monitoring and prompt intervention for MEN, allowing continued chemotherapy.
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