Psoriasis Tanılı Hastada Methotreksat Toksisitesine Bağlı Gelişen Inflamatuar Kolit: Olgu Sunumu

Öz

Inflammatory Colitis Due to Methotrexate Toxicity in a Patient With Psoriasis: A Case Report

Abstract

Methotrexate is known as a folate antimetabolite. The side effects of methotrexate are not usually seen in low dosages. Here we present a patient with inflammatory colitis due to methotrexate use for psoriasis.
A 29 year-old male who was diagnosed with psoriasis 1 year ago and started to use methotrexate for 2 weeks; applied to emergency with acute abdomen symptoms. According to the tests and examinations the patient was diagnosed with inflammatory colitis due to methotrexate toxicity. The patient was observed for abdominal pain without surgical interventions and had folic acid therapy combined with empiric antibiotherapy. Methotrexate side effects are usually seen as bone marrow suppression and mucosal tissue inflammation therefore some side effects can be missed in clinical examinations. As a result, we should consider that in patients applying to emergency with acute abdomen symptoms drugs can be the cause of this clinical presentation. 

Keywords

• inflammatory colitis
• Methotrexate toxicity
• psoriasis

Kaynakça

1. 1. Lawrence D. Atherton, Edward S. Leıb,Mıchael D. Kaye. Toxic Megacolon Associated With Methotrexate Therapy. Gastroenterology. 1984;86:1583-8.
2. 2. Czarnecka-Operacz M, Sadowska-Przytocka A. The possibilities and principles of methotrexate treatment of psoriasis - the updated knowledge. Postepy dermatologii i alergologii. 2014;31(6):392–400. doi: 10.5114/pdia.2014.47121
3. 3. Peker A, Yarkıcı H, Akar H. Gastrointestinal bleeding secondary to use of high-dose methotrexate: A case report. Journal of Surgery and Medicine. 2018;2(2):151-153. doi: 10.28982/josam.399081
4. 4. Mrowietz U, de Jong EM, Kragballe K, Langley R, Nast A, Puig L et al. A consensus report on appropriate treatment optimization and transitioning in the management of moderate-to-severe plaque psoriasis. J Eur Acad Dermatol Venereol. 2014;28(4):438–53. doi: 10.1111/jdv.12118
5. 5. Demir FT, Tezcan Y, Türkoğlu Z, Başaran Ş. A case of Severe Low-dose Methotrexate-induced Toxicity. Med Bull Haseki 2016;54:252-4. doi: 10.4274/haseki.3202
6. 6. Jariwala P, Kumar V, Kothari K, Thakkar S, Umrigar DD. Acute Methotrexate Toxicity: A Fatal Condition in Two Cases of Psoriasis. Case Reports in Dermatological Medicine 2014; 2014: 946716. Published online 2014 Sep 8. doi: 10.1155/2014/946716