Methotrexate induced ventricular arrhythmia as a medication error: a case report

Methotrexate (MTX) is the most widely used drug in clinical practice for long term treatment of connective tissue disorders. As this drug has narrow therapeutic index, if it goes unmonitored can lead to life threatening complications. Herein we are describing the case of a patient who presented with ventricular arrhythmia, due to failure to execute MTX therapy in the prescribed frequency and took daily dose of MTX which was meant to be taken as a weekly dose pointing to failure of patient education or patient comprehension regarding MTX and finally succumbed due to cardiogenic shock. We concluded this causality as probable/likely category according to WHO-UMC causality categories.

Ameliorative effect of propolis against hepatorenal alterations induced by methotrexate: morphohistopathological study / Efecto protector del propóleo en las alteraciones hepatorrenales inducidas por el metotrexato: estudio morfohistopatológico

Methotrexate (MTX) is widely used in the treatment of some forms of cancer but having severe side effects. The present work aimed to investigate the protective role of propolis treatment against alterations induced by MTX on the hepatic and renal tissues. Rabbits were exposed to MTX (0.25 mg/kg), with or without propolis (50 mg/kg) while hepatic and renal biopsies were examined for histological and histochemical abnormalities. Methotrexate induced hydropic degeneration, pyknosis, sinusoidal dilatation and bile duct hyperplasia in the liver together with renal tubular degeneration, glomerular shrinkage and hyaline droplet precipitation. While propolis partially ameliorated some of the morphometric and biochemical alterations, none of the hepatic alterations induced by MTX was protected by propolis treatment. Nevertheless glomerular shrinkage and renal tubule degeneration were partially protected in animals received both MTX plus propolis. It is concluded that propolis treatment has little or no ameliorative effect in protecting the hepatic and renal tissues from MTX toxicity.

El metotrexato (MTX) es ampliamente utilizado en el tratamiento de algunas formas de cáncer, pero tiene efectos secundarios graves. El presente trabajo tuvo como objetivo investigar el papel protector del tratamiento con própoleo frente a las alteraciones inducidas por el MTX en los tejidos hepático y renal. Se expusieron conejos a MTX (0,25 mg / kg), en grupos con y sin propóleo (50 mg / kg), y se realizaron biopsias hepáticas y renales, que fueron examinadas buscando anomalías histológicas e histoquímicas. El metotrexato indujo la degeneración hidrópica, picnosis, dilatación sinusoidal e hiperplasia del conducto biliar en el hígado, junto con la degeneración tubular renal, la contracción glomerular y la precipitación hialina. Mientras que el propóleo parcialmente mejoró algunas de las alteraciones morfométricas y bioquímicas, ninguna de las alteraciones hepáticas inducidas por MTX fue protegido por el tratamiento con propóleo. Sin embargo, la contracción glomerular y la degeneración de los túbulos renales fueron parcialmente protegidos en animales que recibieron MTX más propóleo. Se concluye que el tratamiento con propóleo tiene poco o ningún efecto mejorador en la protección de los tejidos hepáticos y renales sometidos a la toxicidad de MTX.

One mistake, one life at stake: A case of Methotrexate Toxicity in A 57-Year old male presenting with painful plaques with erosions

Introduction@#Methotrexate is being given by dermatologists in only extreme cases of skin disorders such as in severe Psoriasis Vulgaris. Strict precautionary measures are done to avoid its well-known adverse effects. An early but less common sign of its toxicity are painful erosions on plaques. Methotrexate is an effective but potentially toxic treatment for different severe dermatologic disorders such as in severe Psoriasis Vulgaris. Meticulous and complete history-taking, physical examination and laboratory work-up to come up with a correct diagnosis as well as, knowledge of indications for treatment, proper dosing, folate supplementa-tion, monitoring, proper referral and early detection of its toxicity are important in order to avoid cutaneous and systemic adverse effects including death. @*Case Report@#A case of a 57-year old male with a 2-day history of painful erosions on plaques on both upper and lower extremities after eleven days of taking Methotrexate 2.5mg/tablet one tablet three times a day without folate supplementation. He was then being treated by a general physician as a case of Psoriasis Vulgaris. He was subsequently admitted under the Internal Medicine service due to epigastric pain, nausea, anorexia, generalized body weakness and passage of black tarry stools. He was referred to the Department of Dermatology for the painful erosions on plaques. He expired two days after admission due to Acute Respiratory Failure. Post-mortem Skin punch biopsy was done and revealed chronic eczematous dermatitis consistent with Lichen Simplex Chronicus with superimposed drug induced hypersensitivity reaction.