[Fatal epidermal necrosis due to methotrexate use]

Area of Science:

• Dermatology
• Toxicology
• Pharmacology

Background:

• Psoriasis is a chronic autoimmune condition.
• Methotrexate is a common immunosuppressive drug used for psoriasis.
• Folic acid is often prescribed with methotrexate to mitigate toxicity.

Observation:

• A 53-year-old female psoriasis patient developed painful erosive plaques, oral ulcerations, and leukopenia.
• She was on daily methotrexate 10 mg without folic acid prophylaxis.
• During hospitalization, she experienced pancytopenia, liver failure, and acute kidney injury.

Findings:

• The patient developed severe methotrexate toxicity, including multi-organ failure.
• Toxic shock syndrome was the ultimate cause of death.
• Clinical and histological recognition of methotrexate toxicity is vital.

Implications:

• This case highlights the critical need for folic acid prophylaxis with methotrexate therapy.
• It underscores the importance of vigilant monitoring for methotrexate toxicity in psoriasis patients.
• Prompt recognition and intervention can potentially prevent severe adverse events and improve patient outcomes.