# Mucocutaneous Adverse Effects of Methotrexate Toxicity: A Case Series

## TL;DR

This paper reports five cases of severe methotrexate toxicity, highlighting the importance of proper dosing and early symptom recognition.

## Contribution

The study presents a case series emphasizing the risks of methotrexate overuse and the outcomes of toxicity management.

## Key findings

- Five patients showed severe toxicity from methotrexate overuse, including fever and mucocutaneous lesions.
- Three patients recovered with leucovorin and supportive care, while two died.
- The cases highlight the need for patient education and early toxicity recognition.

## Abstract

Methotrexate is a widely used medication in dermatology, rheumatology, and oncology. However, patient misunderstandings or attempts to expedite symptom relief can lead to overuse, resulting in severe toxicity. This case series presents five instances of methotrexate toxicity due to daily dosing and excessive use for underlying disorders. All patients exhibited fever, skin, and mucosal lesions, alongside abnormal hematological parameters. Management involved immediate cessation of methotrexate, administration of leucovorin rescue therapy, and supportive care. Three patients fully recovered with the resolution of lesions and improved hematological profiles, while two succumbed to the illness. These cases underscore the critical need for early recognition of methotrexate toxicity symptoms and comprehensive patient counseling on proper dosing schedules to prevent such adverse outcomes.