Abstract
Case Description: Case of a 76-year-old woman with history of hypertension, atrial fibrillation, arthritis of unknown origin, and Alzheimer disease who was evaluated for a 2-month history of painful oral mucosa erosions with hemorrhagic crusting accompanied with dysphagia. Lesions were treated unsuccessfully with oral antibiotics. Given no clinical improvement a bullous disease was suspected, and patient was started on prednisone. Laboratory results consisted of pancytopenia, hypoalbuminemia, and acute kidney injury. Tissue cultures were negative for bacteria, fungus, and atypical mycobacteria. Skin biopsy on the right lower abdomen showed ulceration with epidermal dysmaturation and dyskeratosis. Upon further questioning patient reported taking MTX 10 mg daily instead of weekly for her underlying arthritis. MTX was stopped and folic acid replacement was administered with resolution of pancytopenia and mucocutaneous lesions.
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