JAPANESE JOURNAL OF ORAL & MAXILLOFACIAL SURGERY

Vol. 55 No. 5       2009

ISSN: 0021-5163      UBIC: 151-J

ABSTRACT

Methotrexate (MTX) is a useful and commonly employed drug for the treatment of chronic rheumatoid arthritis (RA), as compared with other antirheumatic drugs. This report describes a case of RA with severe stomatitis caused by MTX. A 79-year-old woman visited our hospital because of stomatitis in March 2008. Clinical examination revealed multiple stomatitis of the labial, buccal, and palatal mucosa. Blood examination revealed leukocytopenia, thrombocytopenia, and an increased level of CRP (22.84mg/dl). Her medical history included RA. She had received MTX and prednisolone since November 2001. Our clinical diagnosis was severe stomatitis caused by MTX. MTX was stopped, and she was given calcium folinate. After 6 days, leukocytopenia became worse, and erythrocytopenia developed. Granulocyte-colony-stimulating factor was administered, and the dose of calcium folinate was increased. The patient's general condition and oral mucosal ulcer improved. MTX may lead to an oral mucosal ulcer as a premonitory symptom of myelosuppression. We must bear in mind the side effects of MTX when we examine patients with severe oral ulcers. Keywords: methotrexate, chronic rheumatoid arthritis, oral mucosal ulcer, myelosuppression.

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