Clinical case of an acute toxic-allergic reaction due to single intake of methotrexate

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Abstract

This is the case report of an acute allergic reaction in a patient with psoriatic arthritis due to a single intake of low-dose methotrexate. We review the presentation, laboratory tests and results of autopsy. The management of the disease and its outcome were analyzed according to current treatment recommendations for psoriatic arthritis.

About the authors

Vadim I. Mazurov

North-Western State Medical University named after I.I. Mechnikov

Email: maz.nwgmu@yandex.ru
ORCID iD: 0000-0002-0797-2051
SPIN-code: 6823-5482
Scopus Author ID: 16936315400

head of the department of therapy, rheumatology, examination of temporary disability and the quality of medical care. E.E. Eichwald, w.s. RF, Academician of the Russian Academy of Sciences, MD Professor
 

Russian Federation, 191015, Saint-Petersburg, Kirochnaya street, 41

Mikhail S. Shostak

North-Western State Medical University named after I.I. Mechnikov

Email: mikhail.shostak@szgmu.ru

assistant of the Department of Therapy, Rheumatology, Examination of Temporary Disability and Quality of Medical Care E.E. Eichwald

Russian Federation, 191015, Saint-Petersburg, Kirochnaya street, 41

Elena Yu. Kalinina

North-Western State Medical University named after I.I. Mechnikov

Email: drkalinina@yandex.ru
ORCID iD: 0000-0001-7077-3584
SPIN-code: 1176-5739
Scopus Author ID: 8574527400

Associate Professor, Department of Pathological Anatomy, Ph.D.

Russian Federation, 191015, Saint-Petersburg, Kirochnaya street, 41

Victor V. Ripachev

North-Western State Medical University named after I.I. Mechnikov

Author for correspondence.
Email: ripachev-v-2010@yandex.ru

Assistant of the Department of Therapy, Rheumatology, Examination of Temporary Disability and Quality of Medical Care E.E. Eichwald North-Western State Medical University named after I.I. Mechnikov

Russian Federation, 191015, Saint-Petersburg, Kirochnaya street, 41

Roman A. Bashkinov

North-Western State Medical University named after I.I. Mechnikov

Email: bashkinov-roman@mail.ru

resident of the department of therapy, rheumatology, examination of temporary disability and the quality of medical care. E.E. Eichwald North-Western State Medical University named after I.I. Mechnikov

191015, Saint-Petersburg, Kirochnaya street, 41

References

  1. Российские клинические рекомендации. Ревматология / под ред. Е.Л.Насонова. – М.: ГЭОТАР-Медиа, 2017. – 464 с.: 87-110.
  2. Баткаева Н.В., Коротаева Т.В., Баткаев Э.А. Распространенность псориатического артрита и коморбидных заболеваний у больных тяжелым псориазом: данные ретроспективного анализа госпитальной когорты // Современная ревматология. -2017. – Т. 11. - №1. – С.19-22. Batkaeva NV, Korotaeva TV, Batkaev EA. Prevalence of psoriatic arthritis and comorbidities in patients with severe psoriasis: Data of a retrospective analysis of a hospital cohort. Sovremennaya Revmatologiya=Modern Rheumatology Journal. 2017;11(1):19–22..
  3. Коротаева ТВ, Корсакова ЮЛ, Логинова ЕЮ и др. Псориатический артрит. Клинические рекомендации по диагностике и лечению // Современная ревматология. – 2018. – Т. 12. №2. – С.22–35. Korotaeva TV, Korsakova Yu.L., Loginova EYu, et al. Psoriatic arthritis. Clinical guidelines for diagnosis and treatment. Sovremennaya Revmatologiya=Modern Rheumatology Journal. 2018;12(2):22–35.
  4. Angel Lanas, Maarten Boers, Javier Nuevo . Gastrointestinal events in at-risk patients starting non-steroidal anti-inflammatory drugs (NSAIDs) for rheumatic diseases: the EVIDENCE study of European routine practice. Annals Of The Rheumatic Diseases. 2015 Apr;74(4):675-681. doi: 10.1136/annrheumdis-2013-204155
  5. Чамурлиева МН, Логинова ЕЮ, Коротаева ТВ. Выявляемость псориатического артрита у больных псориазом в дерматологической и ревматологической клинике. Современная ревматология. 2016;10(4):47–50.
  6. Федеральные клинические рекомендации по ведению больных псориазом. Доступно по: https://www.ismos.ru/guidelines/doc/psoriaz.pdf. Ссылка активна на 03.02.2019
  7. Laura C Coates, Philip S Helliwell. Methotrexate efficacy in the Tight Control in Psoriatic arthritis (TICOPA) study. J Rheumatol. 2016 Feb; 43(2): 356–361.
  8. Jonathan West, Simon Ogston, and John Foerster. Safety and Efficacy of Methotrexate in Psoriasis: A Meta-Analysis of Published Trials. PLoS One. 2016; 11(5): e0153740. doi: [10.1371/journal.pone.0153740]
  9. The PLOS ONE Staff. Correction: Safety and Efficacy of Methotrexate in Psoriasis: A Meta-Analysis of Published Trials. PLoS One. 2016; 11(7): e0158928. doi: [10.1371/journal.pone.0158928]

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2. Fig. 2. Bone rods, bone marrow. ×40, stained with hematoxilin and eosin. Bone rods are thickened. The bone marrow is mostly represented by adipose tissue with a substantial depletion of all the sprouts of hematopoiesis

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3. Fig. 3. Bone rods, bone marrow. ×100, stained with hematoxilin and eosin. Bone rods are thickened. The bone marrow is mostly represented by adipose tissue with a substantial depletion of all the sprouts of hematopoiesis

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4. Fig. 4. A kidney. ×200, stained with hematoxylin and eosin. In a few remaining glomeruli loops are collapsed. Also protein deposits, and formation of synechia are observed. The epithelium of the tubules is flattened, with sites of necrosis, the diameter is increased. Large caliber arteries have signs of hyperelastosis and elastofibrosis, with focal calcification

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Copyright (c) 2019 Mazurov V.I., Shostak M.S., Kalinina E.Y., Ripachev V.V., Bashkinov R.A.

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This work is licensed under a Creative Commons Attribution 4.0 International License.

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