Hypereosinophilia as a Rare Side Effect of Methotrexate in a Patient with Erythrodermic Psoriasis: The First Case Report

Thanh Thai Van Le,Giang Huong Tran,Hao Trong Nguyen,Chuyen Thi Hong Nguyen,Chau Van Tro,Trung The Van,Lien Thi Bich Nguyen

doi:10.35248/2155-9554.19.10.501

Abstract

Methotrexate (MTX) has been approved for the treatment of psoriasis and is considered to be effective and relatively safe. This drug was widely used for treatment of psoriasis in Vietnam for many years. Life-threatening MTX toxicity is rare but may rapidly develop when the drug is administered. In line with the interface dermatitis and a remarked eosinophilic infiltration in the cutaneous lesion, the diagnosis of hypereosinophilia as an adverse reaction in our patient was supported by the dramatic improvement of symptoms and decreased eosinophils after withdrawal of MTX. To the best of our knowledge, this is the first case that showed isolated hypereosinophilia as an adverse reaction of MTX in psoriasis treatment that may challenge in early recognition. Awareness and prompt recognition of this severe adverse reaction can result in life-saving discontinuation of MTX.

Highlights

Methotrexate (MTX) has been approved for the treatment of psoriasis and is considered to be effective and relatively safe
Based on the compatible of interface dermatitis with a remarked eosinophilic infiltration can be found in the setting of acute mucocutaneous MTX toxicity [3,5], the diagnosis of hypereosinophilia as a drug adverse reaction was supported by the dramatic improvement of symptoms as well as decreased number of eosinophils after withdrawal of MTX
To the best of our knowledge, our patient was the first case that showed nonspecific clinical manifestations related to a hypersensitive drug reaction including an intense pruritus, severe fatigue and flare of psoriatic lesions that may challenge in early recognition [6]

Summary

INTRODUCTION

Methotrexate (MTX) has been approved for the treatment of psoriasis and is considered to be effective and relatively safe. Renal function tests were all in a normal range One week later, his condition worsened with fever at 39°C, severe itchy, dark erythroderma and some new pustules on his back (Figure 1b). His condition worsened with fever at 39°C, severe itchy, dark erythroderma and some new pustules on his back (Figure 1b) His peripheral eosinophils were increased to 6410 cells/mm. A skin biopsy revealed a psoriasiform epidermal hyperplasia with minor interface changes and remarkably infiltrated eosinophils within the dermis (Figure 1c) The record of his previous hospitalization showed a normal eosinophils count of 280 cells/mm before starting MTX. After discontinuation of MTX, the eosinophil counts rapidly reverted to normal at 70 cells/mm within 2 weeks without any specific treatment His systemic condition gradually improved with fever reduction, itch relief and improvement of cutaneous lesions (Figure 2). We supposed our patient suffered hypereosinophilia alone as a rare side effect of MTX that requires recognizing properly and prescribing appropriate management

DISCUSSION

CONCLUSION