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Methotrexate-Induced Leukocytoclastic Vasculitis.

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A child with acute leukemia developed skin lesions during chemotherapy. These lesions, a rare side effect of methotrexate, resolved after stopping the drug, confirming leukocytoclastic vasculitis.

Keywords:
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Area of Science:

  • Pediatric Oncology
  • Dermatology
  • Pharmacology

Background:

  • Acute leukemia treatment often involves chemotherapy agents like methotrexate and 6-mercaptopurine.
  • Maintenance chemotherapy aims to prevent relapse but can cause various side effects.

Observation:

  • A 10-year-old girl with acute leukemia developed erythematous, tender skin lesions during maintenance therapy.
  • She also exhibited coagulopathy and elevated liver enzymes (transaminitis).
  • Initial differential diagnoses included infections, pyoderma gangrenosum, connective tissue disorders, and drug reactions.

Findings:

  • Discontinuation of oral methotrexate led to the subsidence of skin lesions.
  • Skin biopsy confirmed the diagnosis of leukocytoclastic vasculitis.
  • This indicates a rare cutaneous adverse effect of methotrexate therapy.

Implications:

  • Leukocytoclastic vasculitis is a rare but potential side effect of methotrexate.
  • Clinicians should consider methotrexate-induced vasculitis in patients on chemotherapy presenting with skin lesions.
  • Early recognition and drug withdrawal can manage this adverse event.