Subedi, BibekNeupane, SaraswotiBhandari, SajanaTimilsina, SunilPokhrel, Sudarshan2025-07-282025-07-282025https://hdl.handle.net/20.500.14572/866Bibek Subedi Lotus Skin and Hair Clinic, Boudha, Kathmandu, Nepal Saraswoti Neupane Gandaki Medical College Teaching Hospital and Research Center, Prithvi Chowk, Kaski, Nepal Sajana Bhandari Gandaki Medical College Teaching Hospital and Research Center, Prithvi Chowk, Kaski, Nepal Sunil Timilsina Dirghayu Guru Hospital, Mitrapark, Kathmandu, Nepal Sudarshan Pokhrel Department of Emergency Medicine, Nepal APF Hospital, Balambu, Kathmandu, NepalAbstract Methotrexate is a widely used medication in dermatology, rheumatology, and oncology. However, patient misunderstandings or attempts to expedite symptom relief can lead to overuse, resulting in severe toxicity. This case series presents five instances of methotrexate toxicity due to daily dosing and excessive use for underlying disorders. All patients exhibited fever, skin, and mucosal lesions, alongside abnormal hematological parameters. Management involved immediate cessation of methotrexate, administration of leucovorin rescue therapy, and supportive care. Three patients fully recovered with the resolution of lesions and improved hematological profiles, while two succumbed to the illness. These cases underscore the critical need for early recognition of methotrexate toxicity symptoms and comprehensive patient counseling on proper dosing schedules to prevent such adverse outcomes.en-USOther