RESUMEN
RATIONALE: Methotrexate (MTX) is an antimetabolite of folic acid, which is used for management of ectopic pregnancy. MTX-related toxicity may include cutaneous mucosal damage, bone marrow suppression, gastrointestinal disorders (gastritis, diarrhea, hematitis), liver and kidney function damage, pulmonary toxicity, cardiac toxicity, and nerve toxicity. However, it is not usual for vulvar edema induced by low-dose methotrexate. PATIENT CONCERNS: In this case report, we described a patient with severe vulvar edema and oral cavity ulceration and scalp ulceration induced by low-dose MTX treatment for ectopic pregnancy. Her presenting complaints were pain in the vulva, oral cavity, and scalp. DIAGNOSES: The patient was diagnosed based on clinical findings for MTX toxic reactions. INTERVENTIONS: Vulva was disinfectioned with iodide and Kangfuxin solution, her mouth was rinsed with mouthwash. Three compound glycyrrhizin tablets were orally administered (3âtimes/day). After 10 days, the broken skin and mucous membrane healed. OUTCOMES: The vulvar edema and oral cavity ulceration and scalp ulceration healed. LESSONS: Our study demonstrated that even low-dose MTX can be induced skin and mucosal injury, patients and doctors should timely detection of drug toxicity reactions, immediately rescue, prompt discontinuation of medication, and symptomatic treatment to avoid accidental occurrence.
Asunto(s)
Metotrexato/administración & dosificación , Metronidazol/administración & dosificación , Embarazo Ectópico/tratamiento farmacológico , Vaginitis por Trichomonas/tratamiento farmacológico , Enfermedades de la Vulva/inducido químicamente , Dolor Abdominal/etiología , Administración Oral , Adulto , China , Femenino , Ácido Glicirrínico/administración & dosificación , Ácido Glicirrínico/uso terapéutico , Humanos , Inyecciones Intramusculares , Materia Medica/administración & dosificación , Materia Medica/uso terapéutico , Metotrexato/efectos adversos , Metronidazol/uso terapéutico , Embarazo , Embarazo Ectópico/diagnóstico , Resultado del Tratamiento , Hemorragia Uterina/etiología , Enfermedades de la Vulva/tratamiento farmacológicoRESUMEN
Toxic epidermal necrolysis (TEN) is a rare, life-threatening skin reaction for which there is currently has no standardized treatment, despite its significant mortality. Biological agents such as tumour necrosis factor (TNF)-α antagonists are emerging as a novel treatment for patients with TEN. We report a 32-year-old woman who developed TEN secondary to sulfasalazine, which was treated with infliximab. The infliximab treatment subsequently triggered erosive lichen planus (LP) involving the mouth and vulva. Clinicians should be aware that TNF-α antagonists can cause LP as a paradoxical complication of treatment.