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Accidental Chronic Poisoning with Methotrexate; Report of Two Cases

Reza Bidaki, Mojgan Kian, Hamid Owliaey, Mojtaba Babaei Zarch, Masoud Feysal
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Abstract

Methotrexate has been used widely in dermatology, oncology and rheumatology fields. However, methotrexate-induced mucocutaneous lesions may occur in rare cases. In this case presentation, we report two cases of accidental poisoning with methotrexate. They had accidentally used methotrexate instead of digoxin. This case report emphasizes that early diagnosis and appropriate management is critical in order to improve outcome.  


Keywords

Methotrexate; skin ulcer; toxicity; poisoning; case reports; emergency treatment

References

Shen S, O’Brien T, Yap LM, Prince HM, McCormack CJ. The use of methotrexate in dermatology: a review. Australasian Journal of Dermatology. 2012;53(1):1-18.

Weidmann A, Foulkes AC, Kirkham N, Reynolds N. Methotrexate toxicity during treatment of chronic plaque psoriasis: a case report and review of the literature. Dermatology and therapy. 2014;4(2):145-56.

Tripathi R, Chugh PK, Verma V, Mala YM. Fatal methotrexate toxicity: could it have been avoided? BMJ case reports. 2013;2013.

Cudmore J, Seftel M, Sisler J, Zarychanski R. Methotrexate and trimethoprim-sulfamethoxazole: toxicity from this combination continues to occur. Canadian family physician Medecin de famille canadien. 2014;60(1):53-6.

Czarnecka-Operacz M, Sadowska-Przytocka A. The possibilities and principles of methotrexate treatment of psoriasis - the updated knowledge. Postepy dermatologii i alergologii. 2014;31(6):392-400.

Drug Information for the Health Care Professional. 24 ed: Thomson Micromedex; 2004. 1911 p.

Souza C, Suarez O, Silva T, Gorenstein A, Quintella L, Avelleira J. Ulcerations due to methotrexate toxicity in a psoriasis patient. Anais brasileiros de dermatologia. 2015;91(3):375-7.

Chan BS, Dawson AH, Buckley NA. What can clinicians learn from therapeutic studies about the treatment of acute oral methotrexate poisoning? Clinical Toxicology. 2017;55(2):88-96.

Tan KW, Tay YK. A case of acute methotrexate toxicity. Annals of the Academy of Medicine, Singapore. 2011;40(2):97-9.

Jakubovic BD, Donovan A, Webster PM, Shear NH. Methotrexate-induced pulmonary toxicity. Canadian respiratory journal : journal of the Canadian Thoracic Society. 2013;20(3):153-5.

Shiver MB, Hall LA, Conner KB, Brown GE, Cheung WL, Wirges ML. Cutaneous erosions: a herald for impending pancytopenia in methotrexate toxicity. Dermatology online journal. 2014;20(7).

Chatham WW, Morgan SL, Alarcon GS. Renal failure: a risk factor for methotrexate toxicity. Arthritis and rheumatism. 2000;43(5):1185-6.

Soon C, Ilchyshyn A. Methotrexate toxicity induced by acute renal failure. Journal of the Royal Society of Medicine. 2005;98(2):83-4.

Strang A, Pullar T. Methotrexate toxicity induced by acute renal failure. Journal of the Royal Society of Medicine. 2004;97(11):536-7.

Lawrence C, Dahl M. Two patterns of skin ulceration induced by methotrexate in patients with psoriasis. Journal of the American Academy of Dermatology. 1984;11(6):1059-65.

Çaliskan E, Tunca M, Açikgöz G, Arca E, Akar A. Accidental high-dose methotrexate toxicity due to an electronic prescribing error. Indian journal of dermatology, venereology and leprology. 2013;80(3):268-9.

Koçak A, Koçak O, Aslan F, Tektaş M. Methotrexate toxicity presenting as cutaneous ulcerations on psoriatic plaques. Cutaneous and ocular toxicology. 2013;32(4):333-5.

Bourré-Tessier J, Haraoui B. Methotrexate drug interactions in the treatment of rheumatoid arthritis: a systematic review. The Journal of rheumatology. 2010;37(7):1416-21.

HSDB: METHOTREXATE U.S. National Library of Medicine: TOXNET. Available from: https://toxnet.nlm.nih.gov/cgi-bin/sis/search2/r?dbs+hsdb:@term+@DOCNO+3123.

Tuffaha H, Al Omar S. Glucarpidase for the treatment of life-threatening methotrexate overdose. Drugs of today (Barcelona, Spain: 1998). 2012;48(11):705-11.




DOI: https://doi.org/10.22037/emergency.v5i1.15355

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