Indian Journal of Critical Care Medicine

Register      Login



Volume / Issue

Online First

Related articles

VOLUME 22 , ISSUE 10 ( 2018 ) > List of Articles


Methotrexate-induced toxic epidermal necrolysis: A rare case report and review of literature

Pritam Kataria, Pradip Kendre, Apurva Patel, Nahush Tahiliani, Sushant Ikhar

Keywords : Acute lymphoblastic leukemia, methotrexate, toxic epidermal necrolysis

Citation Information : Kataria P, Kendre P, Patel A, Tahiliani N, Ikhar S. Methotrexate-induced toxic epidermal necrolysis: A rare case report and review of literature. Indian J Crit Care Med 2018; 22 (10):740-742.

DOI: 10.4103/ijccm.IJCCM_212_18

License: CC BY-ND 3.0

Published Online: 01-06-2018

Copyright Statement:  Copyright © 2018; The Author(s).


Acute lymphoblastic leukemia (ALL) is the most common malignancy in pediatric patients, and it is characterized by the presence of malignant lymphoblasts within the bone marrow and peripheral blood. The treatment of ALL involves induction, consolidation, reinduction, and maintenance therapy. Consolidation therapy in ALL-Berlin-Frankfurt-Münster 90 protocol involves the use of high-dose methotrexate (HDMTX, 5 g/m2) over 24 h as continuous infusion. The adverse effects due to HDMTX include renal dysfunction in 2%–12% patients, which can lead to increased systemic MTX exposure, leading to further myelosuppression, mucositis, hepatotoxicity, skin toxicity, and, in severe cases, multiorgan failure. Dermatologic toxicity due to MTX includes morbilliform drug rash, photoreactivation, photoenhancement, and skin hyperpigmentation. Stevens–Johnson syndrome and toxic epidermal necrolysis (TEN) are rare and possibly fatal reaction which can occur with MTX. Here, we describe a patient with B-cell ALL who developed TEN after administration of HDMTX.

PDF Share
  1. Fritsch PO, Sidoroff A. Drug-induced Stevens-Johnson syndrome/toxic epidermal necrolysis. Am J Clin Dermatol 2000;1:349-60.
  2. Stoller RG, Hande KR, Jacobs SA, Rosenberg SA, Chabner BA. Use of plasma pharmacokinetics to predict and prevent methotrexate toxicity. N Engl J Med 1977;297:630-4.
  3. Mitchell MS, Wawro NW, DeConti RC, Kaplan SR, Papac R, Bertino JR, et al. Effectiveness of high-dose infusions of methotrexate followed by leucovorin in carcinoma of the head and neck. Cancer Res 1968;28:1088-94.
  4. Abrey LE, DeAngelis LM, Yahalom J. Long-term survival in primary CNS lymphoma. J Clin Oncol 1998;16:859-63.
  5. Ackland SP, Schilsky RL. High-dose methotrexate: A critical reappraisal. J Clin Oncol 1987;5:2017-31.
  6. Goldman ID, Matherly LH. The cellular pharmacology of methotrexate. Pharmacol Ther 1985;28:77-102.
  7. Green MR, Chowdhary S, Lombardi KM, Chalmers LM, Chamberlain M. Clinical utility and pharmacology of high-dose methotrexate in the treatment of primary CNS lymphoma. Expert Rev Neurother 2006;6:635-52.
  8. Meyers PA, Flombaum C. High-dose methotrexate-induced renal dysfunction: Is glucarpidase necessary for rescue? J Clin Oncol 2011;29:e180.
  9. Olsen EA. The pharmacology of methotrexate. J Am Acad Dermatol 1991;25:306-18.
  10. Copur S, Dahut W, Chu E, Allegra CJ. Bone marrow aplasia and severe skin rash after a single low dose of methotrexate. Anticancer Drugs 1995;6:154-7.
  11. Lawrence CM, Dahl MG. Two patterns of skin ulceration induced by methotrexate in patients with psoriasis. J Am Acad Dermatol 1984;11:1059-65.
  12. Martins da Cunha AC, Rappersberger K, Gadner H. Toxic skin reaction restricted to palms and soles after high-dose methotrexate. Pediatr Hematol Oncol 1991;8:277-80.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.