Atypical methotrexate dermatitis and vasculitis in a patient with ankylosing spondylitis

Reports of histologically proven low-dose methotrexate (MTX)-induced vascul itis are uncommon and mostly found for patients with rheumatoid arthritis. Herein we present a patient with ankylosing spondylitis who developed large atypical erythematopurpuric cutaneous lesions after the second oral dose o f 7.5 mg MTX therapy. The histological findings of a cutaneous lesion were consistent with vasculitis, The skill lesions regressed significantly after the discontinuation of MTX therapy. As the clinical picture of the patient 's rheumatological condition became progressively severe, prednisolone ther apy was initiated 8 days later and the skin rash resolved completely ill a couple of weeks.