银屑病并发甲氨蝶呤中毒

Methotrexate toxicity during the treatment of psoriasis:a case report

报告银屑病患者甲氨蝶呤中毒1例。患者男,50岁。全身反复红斑鳞屑10余年,静脉滴注甲氨蝶呤100 mg,每日1次,共2 d,皮损加重伴糜烂疼痛3 d。皮肤科检查:躯干四肢散在大小不一的暗红斑及斑块,上覆鳞屑,部分红斑及斑块糜烂,口腔出现数片蚕豆大糜烂面。皮损组织病理:表皮角化过度伴角化不全,棘层肥厚,表皮突延长增宽,棘层内少量炎性细胞外渗,部分细胞排列稍紊乱,并见较多角化不良细胞,真皮浅层血管扩张迂曲,有散在或小片状淋巴细胞及组织细胞浸润,见嗜酸性粒细胞。实验室检查示白细胞、血小板减少,肝功异常。诊断:甲氨蝶呤中毒。

We report a case of methotrexate-induced cutaneous erosions in a psoriatic patient. A 50-year-old man with a 10-year-history of psoriasis presented multiple painful erosions for 3 days following intravenous methotrexate at dose of 1130 mg once daily for 2 days. Dermatological examination revealed dark erythemas and plaques with scales and some with ero- sions on the trunk and extremities. Oral mucosal erosions were also observed. Skin biopsy showed epidermal hyperkeratosis, parakeratosis, and acanthosis. Rete ridges became elongated and broadened. Dyskeratotic and disarranged keratinocytes along with inflammatory infiltrates were also present. In the upper dermis, ectatic vessels, perivascular infiltration of lymphoeytes, histiocytes and eosinophils were evident. The laboratory tests revealed leukopenia, thrombopenia and abnormal liver function. According to the clinical and histopathologic features, and the laboratory test findings, the diagnosis of methotrexate toxicity was made.