Methotrexate toxicity encountered in dermatology department: A retrospective study at tertiary care center in western India

Abstract

Methotrexate (MTX) is considered a relatively safe drug when prescribed at dose ranging from 7.5mg-30mg per week. Severe acute toxicity is rare and present with mucositis, cutaneous ulceration and pancytopenia. Most cases occur as the result of inadvertent overdosing due to erroneously taking the drug daily. A retrospective study of 10 cases of acute methotrexate toxicity in patients attending the dermatology OPD at P. D. U govt. medical College and hospital, Rajkot during a period of 1 year was done. Out10 patients, 7 had both oral and cutaneous involvement, 4 had genital mucosal involvement while 2 cases had only oral ulcerations. Organ -specific toxicities includes pancytopenia in all cases, as well as hepatoxicity, renal toxicity, and GI toxicity in 3 patients. Additionally, cutaneous toxicity was observed in 6 cases. “Of the 10 patients, 2 recovered after stopping methotrexate with supportive care. The remaining 8 received injectable folinic acid, resulting in recovery for 6 patients, but 2 patients unfortunately died during treatment. Although MTX appears to be a safe and effective medication when used at low-dose, acute MTX toxicity can be a life threating emergency when comorbidities are not addressed. Sensitization amongst doctors, general practitioners and resident doctors is of paramount importance to identify possible MTX toxicity in earlies phases and in a way ensure earliest management.