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Methotrexate-Induced Cutaneous Ulcers: A Rare Side Effect.

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Summary
This summary is machine-generated.

Methotrexate can cause painful skin ulcers, a rare side effect. This case suggests these methotrexate-induced cutaneous ulcerations may signal dangerous pancytopenia.

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Area of Science:

  • Rheumatology
  • Dermatology
  • Oncology

Background:

  • Methotrexate is a common treatment for autoimmune diseases like rheumatoid arthritis.
  • While generally safe, methotrexate has known side effects.
  • Methotrexate-induced cutaneous ulceration is a rare but serious adverse event.

Observation:

  • A 73-year-old female with seronegative rheumatoid arthritis developed painful ulcerative nodules on her hands after a methotrexate dose increase.
  • The patient also presented with pancytopenia, a significant drop in all blood cell types.

Findings:

  • Discontinuation of methotrexate and administration of leucovorin led to the resolution of cutaneous ulcers within two weeks.
  • This case, the ninth reported, links methotrexate-induced cutaneous ulceration to potentially life-threatening pancytopenia.

Implications:

  • Methotrexate-induced cutaneous ulceration may serve as an early clinical sign of methotrexate-induced bone marrow suppression.
  • Clinicians should consider methotrexate-induced cutaneous ulceration as a potential indicator of pancytopenia in patients on methotrexate therapy.
  • Prompt recognition and management, including methotrexate withdrawal and leucovorin rescue, are crucial for patient recovery.