On 23/9, a hospital representative reported a 50-year-old male patient with lichen planus who mistakenly took 10 mg of methotrexate daily for five consecutive days, instead of the prescribed weekly 10 mg dose. He subsequently developed red, swollen, and painful lesions in the genital and anal areas. Despite this, he continued self-medicating with the same dosage for another five days.
His condition worsened, requiring hospitalization. Tests revealed liver enzymes four times higher than normal. He was diagnosed with acute methotrexate poisoning.
In another case, a 55-year-old patient with plaque psoriasis also mistakenly took 10 mg of methotrexate daily for four consecutive weeks instead of weekly. This resulted in poisoning with widespread skin and mucous membrane erosion, necrosis, and bone marrow suppression leading to a rapid decrease in platelets and white blood cells, increasing the risk of systemic infection.
Doctor Quach Thi Ha Giang, head of the Male Dermatology Department, said these patients were treated with fluids, urine alkalization, and folic acid supplements. They also received blood-forming factors and granulocyte colony-stimulating factors when white blood cell counts fell below 0.5 G/L, and combination antibiotics for signs of infection. Comprehensive skin and mucous membrane wound care was also provided.
"The patients recovered well, their general condition stabilized, their skin and mucous membranes healed, digestive disorders resolved, and bone marrow and liver function improved," Dr. Giang said.
Methotrexate (MTX) is an immunosuppressant and anti-inflammatory drug commonly used to treat psoriasis, atopic dermatitis, and autoimmune diseases. It is effective, safe, and inexpensive, leading to widespread prescription. MTX is available in oral and injectable forms and requires doctor supervision.
Dr. Giang warned that methotrexate is a weekly, not a daily, medication, a common error. Patients should carefully read prescriptions, follow instructions, avoid changing dosages, and refrain from taking advice from non-medical professionals.
Acute methotrexate poisoning can cause mucosal and skin ulcers, bone marrow suppression, and liver, kidney, and central nervous system damage. Complications can develop rapidly and become severe and difficult to manage if detected late, potentially leading to death.
Le Nga
