Ozkol Hatice Uce, Toptas Tayfur, Calka Omer, Akdeniz Necmettin
Department of Dermatology, Yuzuncu Yil University, Faculty of Medicine , Van , Turkey .
Cutan Ocul Toxicol. 2015;34(2):173-5. doi: 10.3109/15569527.2014.918139. Epub 2014 Jun 25.
Methotrexate (MTX) remains one of the most frequently used anti-metabolite agents in dermatology. MTX is an analog of folate that competitively and irreversibly inhibits dihydrofolate reductase. Oral mucositis is a common side effect of chemotherapy drugs and is characterized by erythema, pain, poor oral intake, pseudomembranous destruction, open ulceration and hemorrhage of the oral mucosa. In this paper, we report a 32-year-old female with a case of mucositis due to MTX intoxication that resulted from an overdose for rheumatoid arthritis. The patient had abdominal pain, vomiting, and nausea. During follow-up, the patient's white blood cell count was found to be 0.9 × 10(9)/L (4-10 × 10(9)/L). The patient developed fever exceeding 40 °C. The patient was consulted to the hematology service. They suggested using granulocyte colony-stimulating factor for febrile neutropenia. On the fifth day of treatment, the white blood cell count reached 5.3 × 10(9)/L and the patient's fever and mucositis started to resolve. Here, we presented a case of hemorrhagic mucositis and febrile neutropenia resulted from high-dose MTX that responded very well to granulocyte colony-stimulating factor treatment and we reviewed the literature.
甲氨蝶呤（MTX）仍然是皮肤科最常用的抗代谢药物之一。MTX是叶酸类似物，可竞争性且不可逆地抑制二氢叶酸还原酶。口腔黏膜炎是化疗药物的常见副作用，其特征为口腔黏膜红斑、疼痛、进食不佳、假膜性破坏、开放性溃疡和出血。在本文中，我们报告了一名32岁女性，因类风湿关节炎过量服用MTX导致中毒性黏膜炎。患者出现腹痛、呕吐和恶心。随访期间，发现患者白细胞计数为0.9×10⁹/L（4 - 10×10⁹/L）。患者体温超过40°C。患者被转诊至血液科。他们建议使用粒细胞集落刺激因子治疗发热性中性粒细胞减少症。治疗第5天，白细胞计数达到5.3×10⁹/L，患者的发热和黏膜炎开始消退。在此，我们呈现了一例因高剂量MTX导致的出血性黏膜炎和发热性中性粒细胞减少症病例，该病例对粒细胞集落刺激因子治疗反应良好，并且我们回顾了相关文献。
