Mucous membrane ulcerations secondary to methotrexate in a patient with unruptured tubal ectopic pregnancy: a case report

Abstract

Ectopic pregnancy remains a significant contributor to first trimester maternal mortality, though early diagnosis now allows for successful medical management in hemodynamically stable unruptured ectopic patients. Methotrexate is the drug of choice in such scenarios, with known side effects including gastrointestinal discomfort and myelosuppression. We present a rare case of a 29-year-old primigravida with a right tubal unruptured ectopic pregnancy managed with multiple dose methotrexate regimen. Despite stable blood counts and normal organ function, the patient developed severe oral and vulvar mucositis by day 6 of the treatment. Examination revealed multiple painful aphthous ulcers and erythema affecting the buccal mucosa and labia minora. The mucositis resolved completely by day 25 with symptomatic treatment including antihistamines, topical agents and delayed vitamin supplementation. This case highlights an uncommon presentation of methotrexate toxicity with isolated orogenital ulceration occurring in the absence of pancytopenia or systemic toxicity. Early recognition of mucosal lesions is critical for prompt management and may prevent progression to more severe toxicity.