Methotrexate in the Treatment of Recalcitrant Nodular Vasculitis
We report a case of recalcitrant nodular vasculitis in a 23 years old male who was treated successfully with methotrexate. He presented to our Dermatology out Patient Department, Tribhuvan university teaching hospital with complaints of recurrent painful discharging ulcer over bilateral calf and lower legs of three years duration. The diagnosis of nodular vasculitis was made on the basis of the clinical presentation and the histopathological findings. The patient was treated with antituberculosis treatment with initial good response; however the lesions persisted later on, despite completing the course of ATT. The patient did not respond to treatment with systemic corticosteroids also. On starting methotrexate, the lesion started healing within a period of two weeks and there
was significant improvement in subsequent one month. This case report highlights the efficacy of methotrexate in the treatment of recalcitrant nodular vasculitis.
Keywords: ATT; methotrexate; nodular vasculitis.
edn. UK:Wiley- Blackwell 2010; chapter 50, Vasculitis,
Neutrophilic Dermatoses and Related Disorders; pages
2. Requena L, Sánchez YE.Panniculitis. Part II.
Mostly lobular panniculitis. J Am Acad Dermatol. 2001 Sep;
3. Mascaró JM Jr, Baselga E.Erythema induratum of bazin.
DermatolClin. 2008 Oct;26(4):439-45.
4. Gilchrist H, Patterson JW. Erythema nodosum and erythema
induratum (nodular vasculitis): diagnosis and management.
DermatolTher. 2010 aJul-Aug;23(4):320-7.
5. Segura S, Pujol RM, Trindade F, Requena L.Vasculitis in ery
thema induratum of Bazin: a histopathologic study of 101 bi
opsy specimens from 86 patients. J Am AcadDermatol. 2008
6. Nath et al,NodularVasculitis Responding to Dapsone.
Egyptian Dermatology Online Journal 2010 Dec; 6(2):11.
7. Taverna JA, Radfar A, Pentland A, Poggioli G, Demierre
MF. Case reports: nodular vasculitis responsive
to mycophenolate mofetil.J Drugs Dermatol. 2006
8. Prajapati V, Steed M, Grewal P, Mahmood MN, Verma
G, Brassard A.Erythema induratum: case series illustrating
the utility of the interferon-γ release assay in determining the
association with tuberculosis. J Cutan Med Surg. 2013 Oct;17
9. Shen S, O'Brien T, Yap LM, Prince HM, McCormack CJ. The
use of methotrexatein dermatology: a review.Australas J
Dermatol. 2012 Feb;53(1):1-18.
10. Malaviya AN, Sharma A, Agarwal D, Kapoor S, Garg
S, Sawhney S.Low-dose and high-dose methotrexate are tw
o different drugs in practical terms.Int J Rheum Dis. 2010
JNMA allow to read, download, copy, distribute, print, search, or link to the full texts of its articles and allow readers to use them for any other lawful purpose. The author(s) are allowed to retain publishing rights without restrictions. The JNMA work is licensed under a Creative Commons Attribution 4.0 International License. More about Copyright Policy.