Thursday, 15 October 2015
Hall D1 Foyer (Floor 3) (Coex Convention Center)
Young-Hee Nam, MD
,
Internal Medicine, Dong-a University School of Medicine, Busan, South Korea
Dong Sub Jeon, MD
,
Internal Medicine, Dong-a University School of Medicine, Busan, South Korea
Hee-Joo Nam
,
Dong-a University Hospital Regional Pharmacovigilance Center, Busan, South Korea
Yeo Myeong Noh, Nurse
,
Dong-a University Hospital Regional Pharmacovigilance Center, Busan, South Korea
Sang Hee Kim Kim, Nurse
,
Dong-a University Hospital Regional Pharmacovigilance Center, Busan, South Korea
Ye Suel Park
,
Dong-a University Hospital Regional Pharmacovigilance Center, Busan, South Korea
Soo-Keol Lee, MD, PhD
,
Internal Medicine, Dong-a University School of Medicine, Busan, South Korea
Stevens-Johnson syndrome (SJS) is severe acute mucocutanous bullous disorders that are most commonly drug-induced. Antibiotics are the most common cause of SJS, followed by analgesics, nonsteroidal anti-inflammatory drugs, anticonvulsants, and antigout drugs. Methotrexate, a folic acid antagonist, has been used in the treatment of psoriasis, rheumatoid arthritis and neoplastic disease including leukemia and lymphoma. Its principal toxic effects are bone marrow suppression, gastrointestinal mucositis, hepatitis, renal impairment, and erythematous rashes. SJS has been reported in a few patients receiving intermediate or high dose methotrexate. Whether the epidermal necrolysis is an allergic or dose-related toxicity reaction is still controversial. We report a case of SJS in a patient receiving low dose methotrexate for psoriasis.
A 67-year-old male presented with a generalized erythematous rash and erosion, and severe oral ulcers. He had started allopurinol and well tolerated for 1 year. The patient had a history of low-dose methotrexate treatment (5 mg/day) 6 days before the development of his complaints. On the second day after methotrexate treatment, erythematous itchy and edematous rash developed on his legs, which spread widely on his trunk and extremities with subsequent bullous formation. He suffered from aggravation of oropharyngeal ulcer. He was admitted to a local hospital and treated with systemic corticosteroids for 5 days. Skin lesions improved, but he was transferred to our hospital for persistent painful ulcer and odynophagia.
He was treated with topical steroid for skin lesion and total parenteral nutrition had been started because he had difficulty in eating. He recovered gradually and was discharged with supportive therapy but without additional systemic corticosteroid.
Acknowledgement
This research was supported by a grant from Ministry of Food and Drug Safety to operation of the regional pharmacovigilance center in 2015.
