Methotrexate-induced toxic epidermal necrolysis: A case report

Methotrexate (MTX) is a folic acid antagonist that inhibits the enzyme dihydrofolate reductase resulting in decreased cell levels of tetrahydrofolate. Adverse cutaneous reactions to MTX are usually doserelated and have been mainly reported in patients receiving extremely large doses of chemotherapy. Toxicity can affect multiple organ systems including bone marrow, liver, intestinal tract, kidneys, lungs, skin, and blood vessels, resulting in death in severe cases. In this report we describe the case of a 9 year old boy who developed toxic epidermal necrolysis after high-dose MTX treatment and discuss the important clinical and therapeutic features of this condition.