Methotrexate Toxicity — SCE Dermatology MCQ
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Correct answer: C — Possible Methotrexate toxicity (folate deficiency/myelosuppression) — check urgent FBC and hold Methotrexate pending results
Oral ulceration in a patient on Methotrexate is a warning sign of Methotrexate toxicity and should be treated as an emergency. It may indicate folate deficiency, myelosuppression (pancytopenia), or overdose. Urgent FBC and renal function should be checked, Methotrexate should be withheld pending results, and folinic acid may be needed if pancytopenia is confirmed. NPSA patient safety alerts specifically identify oral ulceration as an early warning sign of Methotrexate toxicity. Other warning symptoms include sore throat (neutropenia), unexplained bruising/bleeding (thrombocytopenia), and breathlessness (anaemia or pneumonitis). Patients should be educated to recognise and report these symptoms.
Reference: BAD 2016 MTX Guidelines; NPSA