Abstract
A 66-year-old male patient with psoriatic arthritis who received methotrexate (MTX) 25 mg/wk was hospitalized for ureteral reimplantation, presenting nausea, vomiting, loss of appetite, and oral ulceration. Physical examination revealed multiple ulcerations in the lower labial mucosa, with intense painful symptoms and spontaneous bleeding. The diagnostic hypothesis was of ulcerations associated with the drug. Treatment was performed with 0.05% clobetasol propionate with no satisfactory response. Therefore, we chose to perform an incisional biopsy, with a histologic diagnosis of squamous mucosa with moderate chronic lichenoid inflammation and focal subepidermal cleavage. The final diagnosis was of pharmacodermia associated with the use of MTX. The patient was treated with Ad-Muc (Biolab Sanus) and low-intensity laser therapy. Eleven days after starting treatment the patient died. MTX is an immunomodulator with anti-inflammatory action widely used for the treatment of some autoimmune diseases.
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