Methotrexate induced Toxic Epidermal Necrolysis in a Rheumatoid Arthritis Patient: A Case Report

Methotrexate (MTX), a folate antagonist, is a first-line disease-modifying antirheumatic drug (DMARD) used in the treatment of Rheumatoid arthritis (RA), a chronic autoimmune disorder characterized by synovial inflammation and joint destruction1. Despite its efficacy, MTX is associated with severe adverse drug reactions (ADRs), which are classified as Type B reactions—idiosyncratic or hypersensitivity reactions that are unpredictable and often dose-independent. Toxic epidermal necrolysis (TEN), a rare but life-threatening ADR, is a severe mucocutaneous condition characterized by extensive epidermal detachment and mucosal erosions, often triggered by medications. This case highlights the potential for MTX to induce TEN, hepatic failure, and renal failure, emphasizing the critical need for vigilant monitoring, early recognition, and prompt management of MTX toxicity, particularly in high-risk populations with comorbidities Adverse drug reaction was reported to Adverse drug reaction monitoring centre (AMC) and severity was assessed by WHO-UMC Scale. Patient died after 3 days of admission. Score of Toxic epidermal necrolysis (SCORTEN Scale) is used to assess severity of the illness and to predict mortality4.Early diagnosis, withdrawal of offending agent& timely proper supportive management can help in lowering the mortality. Keywords: Methotrexate, Toxic Epidermal Necrolysis, Rheumatoid Arthritis, Adverse Drug Reaction, Hepatic Failure, Renal Failure.