Faculty Bibliography

The possibility of hepatotoxic reactions in 24 patients receiving long-term methotrexate therapy for psoriasis was evaluated by both liver biopsies and technetium TC 99 m sulfur-colloid liver scans. The two diagnostic methods were compared in a retrospective analysis. Six of 17 patients with clinically normal liver biopsy interpretations were found to have abnormal liver scans, while three of five patients with histologically proved fibrosis had completely normal liver scans. We conclude that hepatotoxic reactions from long-term methotrexate use in psoriasis cannot be reliably evaluated by the technetium Tc 99m sulfur colloid liver scan.

Fibrosis of the liver developed to a degree that contraindicated further treatment with methotrexate in 11 of 43 patients who had been receiving maintenance therapy with methotrexate for psoriasis. Liver biopsy had been performed prior to initiation of methotrexate therapy and was repeated at 12- to 18-month intervals. In this retrospective study, age of the patient and duration of therapy have been found to be significant factors in those patients receiving only the weekly oral dosage schedule. Yearly biopsies of the liver are recommended for patients who receive methotrexate throughout their courses of therapy

A patient with pemphigus vulgaris and serious side effects of steroid therapy was treated by exchange plasmapheresis. Eight plasmaphereses were performed over six weeks. Each procedure reduced the serum level of intercellular antibodies by 50% to 87%. A rebound in levels of intercellular antibodies usually followed their depletion but could be minimized or completely suppressed by administration of cyclophosphamide. After six weeks of therapy, clinical symptoms had greatly improved and intercellular antibody levels had decreased from a titer of 5,120 to 160. It is not possible to ascribe these improvements specifically to plasmapheresis since the patient was concurrently receiving low doses of prednisone and intermittent treatment with cyclophosphamide

Hypopigmentation at a site of application of a tourniquet has not to our knowledge been reported in the literature. We are reporting such a case. We have conjectured that this hypopigmentation may be due to temporary anoxia suffered by melanocytes