Abstract
Conflict of interest: none declared. Methotrexate is among the most commonly used systemic agents in dermatology and rheumatology. It was first introduced approximately 50 years ago for the treatment of psoriasis.1 As with other immunosuppressants, a major concern about the use of methotrexate is the occurrence of potentially life‐threatening side‐effects. We report a case of disseminated varicella zoster virus (VZV) infection in a patient with rheumatoid arthritis (RA) treated with methotrexate. A 58‐year‐old woman with RA presented with a rash on the right forehead and a 17‐day history of right‐sided scalp pain radiating to the right jawline. She had been started on oral antibiotics for presumed cellulitis by her general practitioner and subsequently changed over to aciclovir 800 mg five times a day for herpes zoster virus (HZV) infection. She had been diagnosed with early rheumatoid arthritis 5 months before presentation to us and had been started on methotrexate at a dose of 10 mg/week, which had led to an improvement in her RA.
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