Consultation Essay

660 Words Mar 3rd, 2012 3 Pages

Patient Name: Adela Torres

Patient ID: 132463

Consultant: Sachi Kato, MD, Dermatology

Requesting Physician: Leon Medina, MD Internal Medicine

Date of Consult: 06/23/12

Reason for Consult: Previous evaluated stomatitis, possibly methotrexate related.

HISTORY OF PRESENT ILLNESS: The patient is a very pleasant 57-year-old female, a native of Cuba, being seen for evaluation and treatment for sores in her mouth that she had for the last 10 to 12 days. The patient has a long history of severe and debilitating rheumatoid arthritis for which she has had numerous treatments, but over the past 10 years she has been treated with methotrexate quite successfully. Her dosage has varied somewhere between 20 and 25
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IMPRESSION: Erosive stomatitis, probably secondary to methotrexate. Even though the medication has been used for 10 years without any problems, methotrexate may produce an erosive stomatitis and enteritis after such a use. The patient also may have a enteritis that at this point may have become more quiescent, as she notes that she did have some diarrhea about the time her mouth problem developed. She has had no diarrhea today however. She has noted no blood in her stools and has had no episodes of nausea or vomiting. I’m not as familiar with the main cause of erosive stomatitis. I understand that it can cause gastrointestinal upset, but given the choice between the two, I would think the methotrexate is the most likely etiology for the stomatitis.

RECCOMENDED THERAPY: I agree with your therapeutic regimen regarding this condition with the use of prednisone and folic acid. I also agree that the methotrexate must be discontinued in order to produce a resolution of this patient’s skin problem. However in my experience the stomatitis may take a number of weeks to go away completely if a patient has been on methotrexate for an extended period of time, because the medication is stored within the liver and fatty tissue. Topically, I have prescribed Lidex

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