{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T13:16:18Z","timestamp":1788182178727,"version":"build-2803163510"},"reference-count":20,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T00:00:00Z","timestamp":1787875200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["J Oncol Pharm Pract"],"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>High-dose methotrexate (HD-MTX) is a cornerstone in the treatment of acute lymphoblastic leukemia but carries a risk of severe toxicity. Toxic epidermal necrolysis (TEN) is a rare life-threatening adverse reaction.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case report<\/jats:title>\n                    <jats:p>We report the case of a 15-year-old male with high-risk T-cell acute lymphoblastic leukemia who developed fatal TEN following HD-MTX therapy during induction chemotherapy. Ten days after methotrexate administration, the patient developed rapidly progressive epidermal detachment with mucosal involvement.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Management &amp; outcome<\/jats:title>\n                    <jats:p>The clinical course was complicated by tumor lysis syndrome and acute renal failure requiring intensified leucovorin rescue. Skin biopsy confirmed drug-induced TEN, and pharmacovigilance analysis using the ALDEN score strongly implicated methotrexate. Despite intensive supportive care and broad-spectrum antimicrobial therapy, the patient deteriorated and died of multiorgan failure.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>This case highlights the importance of early recognition of methotrexate toxicity, strict renal monitoring, and awareness of drug interactions to prevent fatal outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/10781552261481536","type":"journal-article","created":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T12:43:06Z","timestamp":1787920986000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Fatal toxic epidermal necrolysis induced by high-dose methotrexate in T-cell acute lymphoblastic leukemia"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-7973-9423","authenticated-orcid":false,"given":"Wafa","family":"Chenbah","sequence":"first","affiliation":[{"name":"Farhat Hached Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amira","family":"Guizani","sequence":"additional","affiliation":[{"name":"Farhat Hached Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haifa","family":"Regaieg","sequence":"additional","affiliation":[{"name":"Farhat Hached Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Monia","family":"Guermazi","sequence":"additional","affiliation":[{"name":"Farhat Hached Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Neila","family":"Fathallah","sequence":"additional","affiliation":[{"name":"Farhat Hached Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarra","family":"Saad","sequence":"additional","affiliation":[{"name":"Farhat Hached Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yosra","family":"Ben Youssef","sequence":"additional","affiliation":[{"name":"Farhat Hached Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,8,28]]},"reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.4103\/ijccm.IJCCM_212_18"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0190-9622(97)70029-X"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0151-9638(07)78252-2"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaad.2017.02.021"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/0190-9622(90)70333-D"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.17511\/ijmrr.2017.i05.09"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.5070\/D34JG110CW"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1346-8138.2008.00440.x"},{"key":"e_1_3_2_10_2","first-page":"450","article-title":"Cutaneous ulceration as a sign of methotrexate toxicity","volume":"11","author":"Del Pozo J","year":"2001","unstructured":"Del Pozo J, Mart\u00ednez W, Garc\u00eda-Silva J, et al. Cutaneous ulceration as a sign of methotrexate toxicity. Eur J Dermatol 2001; 11: 450\u2013452.","journal-title":"Eur J Dermatol"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.1097\/MPH.0b013e318168e77c"},{"key":"e_1_3_2_12_2","first-page":"198","article-title":"Neutrophilic eccrine hidradenitis in actinic reticuloid syndrome","volume":"12","author":"Tojo M","year":"2002","unstructured":"Tojo M, Iwatsuki K, Furukawa H, et al. Neutrophilic eccrine hidradenitis in actinic reticuloid syndrome. Eur J Dermatol 2002; 12: 198\u2013200.","journal-title":"Eur J Dermatol"},{"key":"e_1_3_2_13_2","doi-asserted-by":"publisher","DOI":"10.1001\/archderm.1989.01670150123025"},{"key":"e_1_3_2_14_2","doi-asserted-by":"publisher","DOI":"10.1345\/aph.1P404"},{"key":"e_1_3_2_15_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0190-9622(83)70079-4"},{"key":"e_1_3_2_16_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.annder.2012.04.150"},{"key":"e_1_3_2_17_2","article-title":"Differentiating desquamating skin lesions: a case of methotrexate epidermal necrosis","volume":"15","author":"Ansari S","year":"2023","unstructured":"Ansari S, Zamil DH, Rodriguez E, et al. Differentiating desquamating skin lesions: a case of methotrexate epidermal necrosis. Cureus 2023; 15: e50050.","journal-title":"Cureus"},{"key":"e_1_3_2_18_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jbspin.2007.08.013"},{"key":"e_1_3_2_19_2","article-title":"Stevens-Johnson syndrome associated with methotrexate treatment for acute lymphoblastic leukemia: a case report","volume":"116","author":"Ak\u0131nc\u0131 B","year":"2018","unstructured":"Ak\u0131nc\u0131 B, Sivi\u015f Z\u00d6, \u015eahin A, et al. Stevens-Johnson syndrome associated with methotrexate treatment for acute lymphoblastic leukemia: a case report. Arch Argent Pediatr 2018; 116: e459\u2013e462.","journal-title":"Arch Argent Pediatr"},{"key":"e_1_3_2_20_2","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365-4362.2000.00022-3.x"},{"key":"e_1_3_2_21_2","doi-asserted-by":"publisher","DOI":"10.4103\/idoj.IDOJ_256_20"}],"container-title":["Journal of Oncology Pharmacy Practice"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/10781552261481536","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/10781552261481536","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/10781552261481536","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T12:18:43Z","timestamp":1788178723000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/10781552261481536"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,28]]},"references-count":20,"alternative-id":["10.1177\/10781552261481536"],"URL":"https:\/\/doi.org\/10.1177\/10781552261481536","relation":{},"ISSN":["1078-1552","1477-092X"],"issn-type":[{"value":"1078-1552","type":"print"},{"value":"1477-092X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,28]]},"article-number":"10781552261481536"}}