Cutaneous necrotizing vasculitis after low dose methotrexate therapy for rheumatoid arthritis: A possible manifestation of methotrexate hypersensitivity
Case Report
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Summary
Large haemorrhagic and necrotic cutaneous lesions developed after two low dose (5mg) methotrexate injections in a patient suffering from long standing rheumatoid arthritis. Differential clinical diagnosis included factitia dermatitis, infectious processes, pyoderma gangrenosum, rheumatoid neutrophilic dermatitis, necrotizing arteritis and vasculitis. Histological and direct immunofluo-rescent examinations of skin biopsies supported the diagnosis of leucocytoclastic vasculitis. We discuss the respective roles of methotrexate and rheumatoid arthritis in the outbreak of leucocytoclastic vasculitis. Hypersensitivity is strongly suspected.
Key words
Necrotizing Vasculitis Methotrexate Rheumatoid Arthritis HypersensitivityPreview
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References
- 1.Weinblatt ME, Weissman BN, Holdsworth DE, Fraaser PA, Maier AL, Falchuk KR, Coblyn JS. Long-term prospective study of methotrexate in the treatment of rheumatoid arthritis. Arthritis Rheum 1992; 35: 129–37.Google Scholar
- 2.Kremer JM, Phelps CT. Long-term prospective study of the use of methotrexate in the treatment of rheumatoid arthritis. Arthritis Rheum 1992; 35: 138–45.Google Scholar
- 3.Marks CR, Willkens RF, Wilske KR, Brown P. Small-vessel vasculitis and methotrexate. Ann Int Med 1984; 100: 916.Google Scholar
- 4.Navarro M, Pedragosa R, Lafuerza A, Rubio D, Huguet P. Leukocytoclastic vasculitis after high-dose methotrexate. Ann Int Med 1986; 105: 471–2.Google Scholar
- 5.Fondevila CG, Milone GA, Pavlovsky S. Cutaneous vasculitis after intermediate dose of methotrexate. Br J Haematol 1989; 72: 591–2.Google Scholar
- 6.Parent D, Kraft T, Noel JC, Askenasi R, Goldschmidt D, Heenen M, Linkowski P. Cutaneous Munchhausen syndrom with a presentation simulating pyoderma gangrenosum. J Am Acad Dermatol 1994; 31: 1073–4.Google Scholar
- 7.Greer KE. Cutaneous disease and arthritis. In: Dermatological signs of internal diseases. Eds.: Callen JP, Jorizzo JL, Philadelphia, WB Saunders Company, 1988.Google Scholar
- 8.Sànchez JL, Cruz A. Rheumatoid neutrophilic dermatitis. J Am Acad Dermatol 1990; 22: 922–5.Google Scholar
- 9.Lindsay MK, Tavadia HB, Whyte AS, Lee P, Webb J. Acute abdomen in rheumatoid arthritis due to necrotizing arteritis. BMJ 1973; 2: 592–3.Google Scholar
- 10.Glas D, Soter NA, Schur PH. Rheumatoid vasculitis. Arthritis Rheum 1976; 19: 950–2.Google Scholar
- 11.Breatnach SM, Hintner H. Chemotherapeutic agents. In: Adverse drug reactions and the skin. Eds.: Breatnach SM, Hintner H, Oxford, Blackwell scientific publications, 1992.Google Scholar
- 12.Harrison PV. Methotrexate-induced epidermal necrosis. Br J Dermatol 1987; 116: 867–9.Google Scholar
- 13.Bégaud B, Evreux JC, Jouglard J, Lagier G. Imputabilité des effets inattendus ou toxiques des médicaments. Thérapie 1985; 40: 111–8.Google Scholar
- 14.Mehregan DR, Hall MJ, Gibson LE. Urticarial vasculitis: a histopathologic and clinical review of 72 cases. J Am Acad Dermatol 1992; 26: 441–8.Google Scholar
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© Clinical Rheumatology 1997