Methotrexate Induced Oral Ulcer: a Case Report
Corresponding Author(s) : Abhijith Biju
abhijithjb99@gmail.com
International Journal of Allied Medical Sciences and Clinical Research,
Vol. 11 No. 2 (2023): 2023 Volume -11 - Issue 2
Abstract
Methotrexate (MTX) is well known in the treatment of various neoplastic diseases and autoimmune disorders. Methotrexate is known as antimetabolite of the antifolate type. Prolonged use of low dose Methotrexate develop sores in gums, cheeks, and tongue. Folic acid supplements can be used to avoid such conditions. About 11-17% of patients receiving Methotrexate has been diagnosed as oral ulcer. In this case report we are discussing about Oral ulcer induced by Methotrexate.
Keywords
Methotrexate
Folic acid
Oral ulcer
Dihydrofolate reductase
1.
Abhijith Biju, Alina Rajan, Amal A, Shaiju S Dharan. Methotrexate Induced Oral Ulcer: a Case Report. Int. J. of Allied Med. Sci. and Clin. Res. [Internet]. 2023 Jun. 7 [cited 2026 Apr. 12];11(2):203-5. Available from: https://ijamscr.com/ijamscr/article/view/1328
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References
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1. Troeltzsch M, von Blohn G, Kriegelstein S, Woodlock T, Gassling V, Berndt R et al. Oral mucositis in patients receiving low-dose methotrexate therapy for rheumatoid arthritis: report of 2 cases and literature review. Oral Surg Oral Med Oral Pathol Oral Radiol. 2013;115(5):e28-33. doi: 10.1016/j.oooo.2012.12.008, PMID 23601229.
2. Cipriani P, Ruscitti P, Carubbi F, Liakouli V, Giacomelli R. Methotrexate: an old new drug in autoimmune disease. Expert Rev Clin Immunol. 2014;10(11):1519-30. doi: 10.1586/1744666X.2014.962996, PMID 25245537.
3. Jinbu Y, Obi Y, Kawa R, Ikeda K, Kusama M, Tsukinoki K. Oral ulceration due to an antirheumatic drug (methotrexate): report of a case. Oral Med Pathol. 2008;12(3):97-9. doi: 10.3353/omp.12.97.
4. Lee HJ, Hong SK, Seo JK, Lee D, Sung HS. A case of cutaneous side effect of methotrexate mimicking Behçet’s disease. Ann Dermatol. 2011;23(3):412-4. doi: 10.5021/ad.2011.23.3.412, PMID 21909222.
5. Kalantzis A, Marshman Z, Falconer DT, Morgan PR, Odell EW. Oral effects of low-dose methotrexate treatment. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2005;100(1):52-62. doi: 10.1016/j.tripleo.2004.08.020, PMID 15953917.
6. O’dell JR. Methotrexate use in RA. Rheum Dis Clin North Am. 1997;23(4):779-96. doi: 10.1016/S0889-857X(05)70360-4.
7. Tan KW, Tay YK. A case of acute methotrexate toxicity. Ann Acad Med Singapore. 2011;40(2):97-9. doi: 10.47102/annals-acadmedsg.V40N2p97, PMID 21468464.
8. van Ede AE, Laan RF, Blom HJ, De Abreu RA, van de Putte LB. Methotrexate in rheumatoid arthritis: an update with focus on mechanisms involved in toxicity. Semin Arthritis Rheum. 1998;27(5):277-92. doi: 10.1016/s0049-0172(98)80049-8, PMID 9572710.
9. Genestier L, Paillot R, Quemeneur L, Izeradjene K, Revillard JP. Mechanisms of action of methotrexate. Immunopharmacology. 2000;47(2-3):247-57. doi: 10.1016/s0162-3109(00)00189-2, PMID 10878292.
10. Marin MG. Low-dose methotrexate spares steroid usage in steroid-dependent asthmatic patients: a meta-analysis. Chest. 1997;112(1):29-33. doi: 10.1378/chest.112.1.29, PMID 9228353.
References
1. Troeltzsch M, von Blohn G, Kriegelstein S, Woodlock T, Gassling V, Berndt R et al. Oral mucositis in patients receiving low-dose methotrexate therapy for rheumatoid arthritis: report of 2 cases and literature review. Oral Surg Oral Med Oral Pathol Oral Radiol. 2013;115(5):e28-33. doi: 10.1016/j.oooo.2012.12.008, PMID 23601229.
2. Cipriani P, Ruscitti P, Carubbi F, Liakouli V, Giacomelli R. Methotrexate: an old new drug in autoimmune disease. Expert Rev Clin Immunol. 2014;10(11):1519-30. doi: 10.1586/1744666X.2014.962996, PMID 25245537.
3. Jinbu Y, Obi Y, Kawa R, Ikeda K, Kusama M, Tsukinoki K. Oral ulceration due to an antirheumatic drug (methotrexate): report of a case. Oral Med Pathol. 2008;12(3):97-9. doi: 10.3353/omp.12.97.
4. Lee HJ, Hong SK, Seo JK, Lee D, Sung HS. A case of cutaneous side effect of methotrexate mimicking Behçet’s disease. Ann Dermatol. 2011;23(3):412-4. doi: 10.5021/ad.2011.23.3.412, PMID 21909222.
5. Kalantzis A, Marshman Z, Falconer DT, Morgan PR, Odell EW. Oral effects of low-dose methotrexate treatment. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2005;100(1):52-62. doi: 10.1016/j.tripleo.2004.08.020, PMID 15953917.
6. O’dell JR. Methotrexate use in RA. Rheum Dis Clin North Am. 1997;23(4):779-96. doi: 10.1016/S0889-857X(05)70360-4.
7. Tan KW, Tay YK. A case of acute methotrexate toxicity. Ann Acad Med Singapore. 2011;40(2):97-9. doi: 10.47102/annals-acadmedsg.V40N2p97, PMID 21468464.
8. van Ede AE, Laan RF, Blom HJ, De Abreu RA, van de Putte LB. Methotrexate in rheumatoid arthritis: an update with focus on mechanisms involved in toxicity. Semin Arthritis Rheum. 1998;27(5):277-92. doi: 10.1016/s0049-0172(98)80049-8, PMID 9572710.
9. Genestier L, Paillot R, Quemeneur L, Izeradjene K, Revillard JP. Mechanisms of action of methotrexate. Immunopharmacology. 2000;47(2-3):247-57. doi: 10.1016/s0162-3109(00)00189-2, PMID 10878292.
10. Marin MG. Low-dose methotrexate spares steroid usage in steroid-dependent asthmatic patients: a meta-analysis. Chest. 1997;112(1):29-33. doi: 10.1378/chest.112.1.29, PMID 9228353.
2. Cipriani P, Ruscitti P, Carubbi F, Liakouli V, Giacomelli R. Methotrexate: an old new drug in autoimmune disease. Expert Rev Clin Immunol. 2014;10(11):1519-30. doi: 10.1586/1744666X.2014.962996, PMID 25245537.
3. Jinbu Y, Obi Y, Kawa R, Ikeda K, Kusama M, Tsukinoki K. Oral ulceration due to an antirheumatic drug (methotrexate): report of a case. Oral Med Pathol. 2008;12(3):97-9. doi: 10.3353/omp.12.97.
4. Lee HJ, Hong SK, Seo JK, Lee D, Sung HS. A case of cutaneous side effect of methotrexate mimicking Behçet’s disease. Ann Dermatol. 2011;23(3):412-4. doi: 10.5021/ad.2011.23.3.412, PMID 21909222.
5. Kalantzis A, Marshman Z, Falconer DT, Morgan PR, Odell EW. Oral effects of low-dose methotrexate treatment. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2005;100(1):52-62. doi: 10.1016/j.tripleo.2004.08.020, PMID 15953917.
6. O’dell JR. Methotrexate use in RA. Rheum Dis Clin North Am. 1997;23(4):779-96. doi: 10.1016/S0889-857X(05)70360-4.
7. Tan KW, Tay YK. A case of acute methotrexate toxicity. Ann Acad Med Singapore. 2011;40(2):97-9. doi: 10.47102/annals-acadmedsg.V40N2p97, PMID 21468464.
8. van Ede AE, Laan RF, Blom HJ, De Abreu RA, van de Putte LB. Methotrexate in rheumatoid arthritis: an update with focus on mechanisms involved in toxicity. Semin Arthritis Rheum. 1998;27(5):277-92. doi: 10.1016/s0049-0172(98)80049-8, PMID 9572710.
9. Genestier L, Paillot R, Quemeneur L, Izeradjene K, Revillard JP. Mechanisms of action of methotrexate. Immunopharmacology. 2000;47(2-3):247-57. doi: 10.1016/s0162-3109(00)00189-2, PMID 10878292.
10. Marin MG. Low-dose methotrexate spares steroid usage in steroid-dependent asthmatic patients: a meta-analysis. Chest. 1997;112(1):29-33. doi: 10.1378/chest.112.1.29, PMID 9228353.