Analysis of causation of Stevens Johnson Syndrome in a patient of rheumatoid arthritis with increased dose of methotrexate

Rheumatoid arthritis (RA) is an autoimmune disease affecting about 1% of people, with the highest incidence between 40 and 70 years. Methotrexate is a folic acid antagonist that has good efficacy and safety in the treatment of RA. Methotrexate (MTX) and non-steroidal anti-inflammatory drugs are often concomitantly administered in clinical practice for the treatment of RA. In this case report 46 year old male patient, a known case of rheumatoid arthritis was admitted with history of knee joint pain and swelling. Methotrexate was initially started in a dose of 7.5 mg per week, dose was then increased to 15 mg per week. Six weeks later, the patient complained of oral ulcerations, erythematous, itchy and edematous rash on all four limbs and trunk. The patient was re-evaluated and was diagnosed with Stevens-Johnson syndrome. All the previous medications were stopped. The patient was treated with steroids, prophylactic antibiotics and antifungal drugs. The lesions started to heal after 5 days of hospitalization. Thus the treatment of Rheumatoid arthritis with methotrexate should be carefully considered due to its increased toxicity and risk of severe skin reactions.