Oral Ulceration Due to Methotrexate Treatment: A Report of 3 Cases and Literature Review

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Methotrexate (MTX) is an antimetabolite which interferes with DNA synthesis. It is used for the treatment of many diseases, such as psoriasis, rheumatoid arthritis and various neoplastic diseases. It may cause, among various adverse reactions, oral ulceration and oral mucositis. 3 cases of methotrexate related oral ulcers are reported along with a brief review of the relevant literature.

1. Troeltzsch M, von Blohn G, Kriegelstein S, Woodlock T, Gassling V, Berndt R, Troeltzsch M. 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:e28-e33.

2. Lee JH, Hong KS, Seo KJ, Lee D, Sung SH. A Case of Cutaneous Side Effect of Methotrexate Mimicking Behçet’s Disease. Ann Dermatol, 2011; 23(3):412-414.

3. Kalantzis A, Marshman Z, Falconer TD, Morgan RP, Odell WE. Oral effects of low-dose methotrexate treatment. Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 2005; 100:52-62.

4. 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; 12:97-99.

5. Deeming JMG, Collingwood J, Pemberton NM. Methotrexate and oral ulceration. Br Dent J, 2005; 198:83-85.

6. Bauer J, Fartasch M, Schuler G, Schell H. Ulzerierende Stomatitis als klinischer Hinweis auf eine unerkannte Überdosierung von Methotrexat. Hautarzt, 1999; 50:670-673.

7. Pedrazas SHC, de Azevedo LNM, Torres RS. Oral events related to low-dose methotrexate in rheumatoid arthritis patients. Braz Oral Res, 2010; 24(3):368-373.

8. Borchers TA, Keen LC, Cheema SG, Gershwin EM. The Use of Methotrexate in Rheumatoid Arthritis. Seminars in Arthritis and Rheumatism, 2004; 34(1, August):465-483.

9. Gobbo M, Ottaviani G, Bussani R, Pozzato G, Biasotto M. Methotrexate-induced oral mucositis in rheumatoid arthritis disease: Therapeutic strategy in a case report. Photon Lasers Med, 2013; 2(1):71-76.

10. Jinbu Y, Demitsu T. Oral ulcerations due to drug medications. Japanese Dental Science Review, 2014; 50:40-46.

11. Ding C-Z, Yao Y, Feng X-B, Fang Y, Zhao C, Wang Y. Clinical Analysis of Chinese Patients with Rheumatoid Arthritis Treated with Leflunomide and Methotrexate Combined with Different Dosages of Glucocorticoid. Curr Ther Res Clin Exp, 2012; 73:123-133.

12. Warner J, Brown A, Whitmore E, Cowan AD. Mucocutaneous Ulcerations Secondary to Methotrexate. Cutis, 2008; 81:413-416.

13. Epstein BJ, Thariat J, Bensadoun R-J, Barasch A, Murphy AB, Kolnick L, Popplewell L, Maghami E. Oral Complications of Cancer and Cancer Therapy From Cancer Treatment to Survivorship. CA Cancer J Clin, 2012; 62:400-422.

14. Sadasivam N, Johnson JR, Owen GR. Resolution of methotrexate-induced Epstein-Barr virus-associated mucocutaneous ulcer. Br J Haematol, 2014; 165:584.

15. Naidu A, Kessler PH, Pavelka AM. Epstein-Barr Virus-Positive Oral Ulceration Simulating Hodgkin Lymphoma in a Patient Treated with Methotrexate: Case Report and Review of the Literature. J Oral Maxillofac Surg, 2014; 72:724-729.

16. Attard AA, Praveen P, Dunn JSP, James JG. Epstein-Barr virus-positive mucocutaneous ulcer of the oral cavity: the importance of having a detailed clinical history to reach a correct diagnosis. Oral Surg Oral Med Oral Pathol Oral Radiol, 2012; 114:e37-e39.

17. Pastor-Nieto MA, Kilmurray LG, López-Chumillas A, O’Valle F, Garcia-del Moral R, Puig AM, Bautista P. Methotrexate-Associated Lymphoproliferative Disorder Presenting as Oral Ulcers in a Patient with Rheumatoid Arthritis. Actas Dermosifiliogr, 2009; 100:142-146.

18. Dojcinov DS, Venkataraman G, Raffeld M, Pittaluga S, Jaffe SE. EBV Positive Mucocutaneous Ulcer - A Study of 26 Cases Associated With Various Sources of Immunosuppression. Am J Surg Pathol, 2010; 34:405-417.

Balkan Journal of Dental Medicine

Successor of the Balkan Journal of Stomatology

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