Cutaneous necrotizing vasculitis after low dose methotrexate therapy for rheumatoid arthritis: A possible manifestation of methotrexate hypersensitivity |
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| Authors: | Th. Simonart P. Durez J. Margaux J. Van Geertruyden D. Goldschmidt D. Parent MD PhD. |
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| Affiliation: | (1) From the Department of Dermatology, Erasme Hospital, Université Libre de Bruxelles, 808 Route de Lennik, B-1070 Brussels, Belgium;(2) Department of Rheumatology, Erasme Hospital, Université Libre de Bruxelles, 808 Route de Lennik, B-1070 Brussels, Belgium;(3) Department of Plastic Surgery, Erasme Hospital, Université Libre de Bruxelles, 808 Route de Lennik, B-1070 Brussels, Belgium |
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| Abstract: | 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. |
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| Keywords: | Necrotizing Vasculitis Methotrexate Rheumatoid Arthritis Hypersensitivity |
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