Stomatitis possibly methotrexate related

HOSPITAL COURSE
This 57-year-old Cuban female was admitted from my office repeat severe stomatis, and mild volume depletion. Secondary to poor fluid and fluid intake. Initially, the possibility of erythema multiformlike picture was raised because she did have some skin lesions, however; dermatology consultation with Dr. Kato suggest this was most likely methotrexate related. She was given intravenous ?. And high- dose prednisone treatment. This along with her intravenous fluids stabilized her condition. At the time of discharge her oral ulcers have markedly decreased. She could swallow without difficulty, and her p.o. intake was adequate. During hospitalization and after consultation with Dr. Kato, treatment options were discussed with the patient, at this point she has elected to return to treatment with methotrexate bit of a lower dose with concurrent use folic acid.

DIAGNOSTIC DATA
White blood cell count 50 to100, hemoglobin 12, platelet count 422,000 Westergren some occasionally was mildly elevated at 36 mm per hour. Serum cholesterol 120 ng/dl, albumin three, total protein 6.6. Liver enzymes were within normal limits.

DISPOSITION
The patient was discharged in improved condition taking p.o. well.

DISCHARGE MEDICATIONS
Referral from the liver lability profile from the left ear ability liver function have a few ability estradiol 0.5 mg daily and BuSpar 5 mg daily, no diaphoresis was brought to the restrictions. Return levels with an approximately a week. Dr. Kim appearing and controlled with Dr. Dickinson define decided persists.

DISCHARGE DIAGNOSES
No ventricular lead stomatitis through wound.

REFERRING PHYSICIAN
This course lifted for three story on preventative osteoporosis for nephrocalcinosis was five reasons review of of anxiety of this as we delineate the IMA MD of internal medicine signing off.. She can do and either cautery and stores Dickinson Ph.D. psychology