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Lesional infiltration with methotrexate for the treatment of keratoacanthoma (KA) has been proposed as a safe, efficient, and cost-effective alternative therapy when size, localization, and patient-related factors contraindicate surgery.^1-2 We report a case in which single intralesional methotrexate injection led to severe pancytopenia.

Report of a Case

A 69-year-old man presented with a dome-shaped, symmetrical, sharply demarcated, erythematous tumor of 12-mm diameter that developed within 3 weeks at the left nasal orifice. Results from a biopsy were compatible with the clinical diagnosis of KA. Because this patient additionally had multiple internal diseases, including chronic renal failure requiring hemodialysis, to avoid hospitalization for surgery a total 12.5 mg of methotrexate was injected into 4 separate sites of the KA. Three days later, stomatitis developed. Thirteen days after methotrexate infiltration, the patient complained of black and tarry stools. Diagnostic evaluation revealed bleeding from a previously unrecognized gastric ulcer and pancytopenia (thrombocyte count, 14 x 10³/µL; . . . [Full Text of this Article]

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