Dear Editor,Methotrexate (MTX) in low weekly doses is a first-line therapy for inflammatory diseases, such as moderate to severe psoriasisand rheumatoid arthritis1,2due to its effectiveness, low cost and ease of use. Severe acute toxicity is rare and presents with mucositis, skinulceration and pancytopenia.2 Factors such as age, drug interaction,individual susceptibility and comorbidities can contribute to the development of toxicity.3 However, the most common cause is a dailyaccidental ingestion, rather than weekly dose of methotrexate. Theregular monitoring and the selection of patients for the use of this medication, appropriate counseling about drug interactions, adverse effects, as well as instructions on self-medication are essentialto prevent complications. Misunderstanding about its use may lead to severe toxicity and even death.
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