Methotrexate-induced epidermal necrosis (MEN) is an uncommon but potentially fatal complication. We present two pediatric oncology patients, a 5-year-old girl and a 3-year-old boy, who developed MEN from high-dose methotrexate therapy for pre-B-cell acute lymphocytic leukemia. Following administration of systemic methotrexate, the patients developed erythematous lesions with subsequent skin erosions. Pre-medication with systemic corticosteroids and administration of folinic acid rescue following the methotrexate infusion allowed both patients to resume their chemotherapy regimen with methotrexate.
Keywords: adverse drug reaction; antifolate; cytotoxic skin reaction; methotrexate; skin necrosis.
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