A Diagnostic Challenge of  Methotrexate-Induced Mucositis: A Case Report

Katayoun Katebi; Ali Taghavi Zenouz; Mohammad Ali Ghavimi

doi:10.18502/crcp.v7i2.10824

Katayoun Katebi Department of Oral and Maxillofacial Medicine, Faculty of Dentistry, Tabriz University of Medical Sciences, Tabriz, Iran.
Ali Taghavi Zenouz Department of Oral and Maxillofacial Medicine, Faculty of Dentistry, Tabriz University of Medical Sciences, Tabriz, Iran.
Mohammad Ali Ghavimi Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Tabriz University of Medical Sciences, Tabriz, Iran.

DOI: https://doi.org/10.18502/crcp.v7i2.10824

Keywords: Oral Ulcer; Mucositis; Arthritis; Rheumatoid; Methotrexate

Abstract

Methotrexate is an anti metabolite drug that is used for treating several autoimmune diseases in low doses. It has been reported that oral ulcers occur in 11-17% of patients receiving low doses of Methotrexate. The purpose of this article is to report the Methotrexate-induced oral ulcers and their effects on patient’s quality of life. The patient was a 69-year-old woman with a complaint of oral ulcers. She was taking alendronate, Methotrexate, and hydroxychloroquine for osteoporosis and rheumatoid arthritis diseases. The possibility of bisphosphonate-induced osteonecrosis was recognized due to necrotic ulcers with mandibular bone exposure in the first therapy session. Then, a new necrotizing ulcer on the hard palate appeared in the next session. Methotrexate consumption was discontinued and folic acid was initiated. The oral ulcers were fully recovered in three weeks. Methotrexate-induced mucositis should be considered in the differential diagnosis of patients with oral ulcers who receive low-dose Methotrexate.