Borda Luis J, Ross Andrew, Villada Gabriel, Milikowski Clara
Department of Dermatology and Cutaneous Surgery, University of Miami School of Medicine, Miami, Florida, USA.
Department of Pathology and Laboratory Medicine, University of Miami School of Medicine, Miami, Florida, USA.
BMJ Case Rep. 2018 Apr 7;2018:bcr-2017-221489. doi: 10.1136/bcr-2017-221489.
Methotrexate toxicity in mucocutaneous areas is usually not associated with tissue eosinophilia. We describe a case of acute methotrexate-induced mucocutaneous erosions with interface dermatitis and eosinophils. A 76-year-old African-American woman with a history of bullous pemphigoid on methotrexate therapy presented with lower extremity cellulitis, developing oral and cutaneous erosions during hospitalization after daily dosage of methotrexate. Shallow circular cutaneous erosions were found on chest, abdomen and limbs. Laboratory results showed pancytopaenia and elevated liver function tests. Skin biopsy revealed irregular acanthotic epidermis with interface dermatitis, individual dyskeratotic cells and superficial perivascular lymphocytic infiltrate with numerous eosinophils. Methotrexate was stopped and leucovorin was administered, leading to improvement. The histopathological changes in acute mucocutaneous toxicity range from pauci-inflammatory erosions with dyskeratotic keratinocytes to interface dermatitis and infrequently seen eosinophils. This case exemplifies that interface dermatitis with a marked eosinophilic infiltrate can be found in the setting of acute mucocutaneous methotrexate toxicity.
甲氨蝶呤在黏膜皮肤区域的毒性通常与组织嗜酸性粒细胞增多无关。我们描述了一例急性甲氨蝶呤诱发的黏膜皮肤糜烂伴界面性皮炎和嗜酸性粒细胞的病例。一名76岁有大疱性类天疱疮病史且正在接受甲氨蝶呤治疗的非裔美国女性，因下肢蜂窝织炎就诊，在每日服用甲氨蝶呤后住院期间出现口腔和皮肤糜烂。在胸部、腹部和四肢发现了浅圆形皮肤糜烂。实验室检查结果显示全血细胞减少和肝功能检查结果升高。皮肤活检显示表皮棘层增厚不规则，伴有界面性皮炎、个别角化不良细胞以及浅表血管周围淋巴细胞浸润，并伴有大量嗜酸性粒细胞。停用甲氨蝶呤并给予亚叶酸钙后病情好转。急性黏膜皮肤毒性的组织病理学变化范围从伴有角化不良角质形成细胞的轻度炎症性糜烂到界面性皮炎，且嗜酸性粒细胞少见。该病例表明，在急性甲氨蝶呤黏膜皮肤毒性情况下可发现伴有明显嗜酸性粒细胞浸润的界面性皮炎。
