Methotrexate Reactions 1680, p224 - 2 Dec 2017 Skin necrosis and pancytopenia following methotrexate toxicity: case report A 51-year-old man developed skin necrosis and pancytopenia following methotrexate toxicity. The man had a medical history of end-stage renal disease and prurigo nodularis that had failed to respond to topical steroids and narrowband ultraviolet B phototherapy. He was started on treatment with methotrexate 7.5 mg/week [route not stated] for the persistent pruritus after discussion with the nephrologist. Two weeks later, he presented with a 2 week history of acute-onset, painful, violaceous plaques involving the bilateral medial thighs. Ill-defined, violaceous indurated plaques with central erosion and surrounding scale on the bilateral medial thighs and inguinal folds were seen on physical examination. Pancytopenia was observed on lab investigation. Basal vacuolar change with epidermal apoptosis and oedema, and a superficial dermal infiltrate consisting of lymphocytes, neutrophils and eosinophils with mild haemorrhage were seen in the histopathological examination of a punch biopsy. The man was given supportive treatment and the cell counts returned to baseline. While the cutaneous healed after discontinuation of methotrexate. Author comment: "Ours is the seventh reported case of [methotrexate]-induced cutaneous erosions in a patient without psoriasis." Merkel EA, et al. Painful, violaceous plaques in a patient with pruritus. Clinical and Experimental Dermatology 42: 931-933, No. 8, Dec 2017. Available from: URL: - USA 803284376 0114-9954/17/1680-0001/$14.95 Adis © 2017 Springer International Publishing AG. All rights reserved Reactions 2 Dec 2017 No. 1680 Reactions Weekly Springer Journals


Reactions Weekly , Volume 1680 (1) – Dec 2, 2017
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Springer International Publishing
Copyright © 2017 by Springer International Publishing AG, part of Springer Nature
Medicine & Public Health; Drug Safety and Pharmacovigilance; Pharmacology/Toxicology
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