Contents

SynopsisCodesLook ForDiagnostic PearlsDifferential Diagnosis & PitfallsBest TestsManagement PearlsTherapyDrug Reaction DataReferences

View all Images (7)

Methotrexate-induced mucocutaneous toxicity
Other Resources UpToDate PubMed

Methotrexate-induced mucocutaneous toxicity

Contributors: Connie R. Shi MD, Susan Burgin MD, Fatima Ghandour, Paritosh Prasad MD
Other Resources UpToDate PubMed

Synopsis

Mucocutaneous toxicity in the form of necrosis, erosions, and ulcers can occur in patients taking low-dose or high-dose methotrexate (MTX). MTX-induced skin necrosis (MEN) is a rarer form of skin toxicity, which simulates Stevens-Johnson syndrome / toxic epidermal necrolysis (SJS/TEN) and may also be accompanied by mucosal ulceration.

Some risk factors for developing mucocutaneous toxicity include age older than 55 years; renal impairment; lack of folate supplementation or folate deficiency; taking incorrect MTX dosages; newly starting, increasing, or adjusting MTX dosages; low serum albumin; and concomitant use of medications such as NSAIDs or trimethoprim-sulfamethoxazole, among others.

The appearance of skin toxicity may indicate the impending onset of life-threatening pancytopenia and organ failure. Drug cessation typically results in rapid healing and recovery of mucocutaneous involvement; however, a few instances of MTX mucocutaneous toxicity have been associated with complications such as multiorgan failure, sepsis, pulmonary edema, and other life-threatening complications. Factors such as lack of folic acid supplementation, pancytopenia, and renal dysfunction have an increased association with mortality from MTX toxicity.

Codes

ICD10CM:
L27.0 – Generalized skin eruption due to drugs and medicaments taken internally
T45.1X1A – Poisoning by antineoplastic and immunosuppressive drugs, accidental (unintentional), initial encounter

SNOMEDCT:
290680001 – Methotrexate poisoning
95346009 – Mucocutaneous ulcer

Look For

Subscription Required

Diagnostic Pearls

Subscription Required

Differential Diagnosis & Pitfalls

To perform a comparison, select diagnoses from the classic differential

Subscription Required

Best Tests

Subscription Required

Management Pearls

Subscription Required

Therapy

Subscription Required

Drug Reaction Data

Subscription Required

References

Subscription Required

Last Reviewed:03/23/2024
Last Updated:04/07/2024
Copyright © 2024 VisualDx®. All rights reserved.
Methotrexate-induced mucocutaneous toxicity
Print   View all Images (7)
(with subscription)
A medical illustration showing key findings of Methotrexate-induced mucocutaneous toxicity : Oral mucosa, Ulcers
Copyright © 2024 VisualDx®. All rights reserved.