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Painful erosions on psoriatic plaques: cutaneous clue to life-threatening methotrexate overdose
  1. Anuradha Bishnoi,
  2. Ankur Guliani,
  3. Tarun Narang,
  4. Sunil Dogra
  1. Department of Dermatology, Venereology and Leprology, PGIMER, Chandigarh, India
  1. Correspondence to Dr Tarun Narang, Dermatology, Venereology and Leprology, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India; narangtarun{at}yahoo.co.in

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A 50-year-old man presented for evaluation of painful, bleeding lesions on his body of 3 days’ duration. His medical history was significant for chronic plaque-type psoriasis of 15 years’ duration. Examination revealed well defined, erythematous plaques with multiple curvilinear and circular, tender haemorrhagic erosions, ulcers and fissures on top of these and an almost normal intervening skin on both the upper and lower limbs, predominantly extensor aspect (figure 1). The lesions involved his palms and soles too. There was diffuse erythema in the oral cavity.

Figure 1

Cutaneous ulcerations in methotrexate overdose. Well defined, erythematous plaques with multiple curvilinear and circular, tender haemorrhagic erosions, ulcers and fissures on top of these plaques., The erosions developed after an inadvertent daily intake of methotrexate. (A, B) Lesions on forearms. (C) Lesions on dorsa of hands with haemorrhagic thickened discoloured nails. (D, E) …

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Footnotes

  • Contributors AB and TN had full access to all the data used in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: AB and AG. Acquisition, analysis and interpretation of data: AB, AG, TN and SD. Drafting of the manuscript: AB and AG. Critical revision of the manuscript for important intellectual content: TN and SD. Statistical analysis: None. Administrative, technical or material support: None. Study supervision: TN.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; internally peer reviewed.

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