CASE REPORT article
Front. Pharmacol.
Sec. Predictive Toxicology
Volume 16 - 2025 | doi: 10.3389/fphar.2025.1704810
This article is part of the Research TopicEnhancing toxicity prediction through adverse outcome pathways: A comprehensive approachView all articles
A rare case of low-dose methotrexate toxicity leading to skin and mucosal toxicity and invasive pulmonary mucormycosis :a case report
Provisionally accepted
- 1Shandong University of Traditional Chinese Medicine, Jinan, China
- 2Taian City Central Hospital, Tai'an, China
- 3Shandong University of Traditional Chinese Medicine Affiliated Hospital, Jinan, China
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Methotrexate is a potentially toxic antifolate antineoplastic and immunosuppressive agent, widely used in tumor chemotherapy and autoimmune diseases (such as psoriasis). It is the cornerstone therapy for immune-mediated disorders worldwide. However, low-dose methotrexate therapy for psoriasis rarely causes toxicity. Here, we report a case of a patient with psoriasis who was treated with low-dose methotrexate for the first time. The patient developed severe mucosal ulcers and myelosuppression, leading to impaired immunity and invasive pulmonary mucormycosis. After treatment, the patient recovered and was discharged. It demonstrates that even low-dose methotrexate prescribed for psoriasis can induce severe toxicity. The case highlights the potential for low-dose methotrexate toxicity, suggesting that genetic polymorphisms may increase the risk of toxicity. The influence of genetic polymorphisms on methotrexate metabolism is highly variable. It is important to strengthen early monitoring in clinical practice, improve toxicity prediction models, and establish risk assessment systems for toxic drugs.
Keywords: Idiosyncratic reaction1, Low dose methotrexate2, Mucocutaneous ulcer3, Impairedimmunity4, Opportunistic infections5
Received: 13 Sep 2025; Accepted: 20 Oct 2025.
Copyright: © 2025 Luo, Xue, Li, Lei, Zhao, Zhang and Zhang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
gong Xing Xue, xuexinggong@163.com
Hui Li, lihui_tcm@126.com
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