Purpose A case of methotrexate toxicity from intralesional treatment of squamous cell carcinoma of the hands in a peritoneal dialysis patient is reported. Summary A 68-year-old Caucasian man receiving peritoneal dialysis for end-stage renal disease complained to his primary care physician of shortness of breath, mouth and hand sores, nausea, and general malaise. Four days before his office visit, the patient received 25 mg of methotrexate intralesionally for refractory squamous cell carcinoma of his hands. The patient had several pustular lesions on both hands. On admission, the patient had a normal complete blood cell count and elevated liver enzyme levels. On hospital day 3, the patient’s white blood cell count was 1,300 cells/μL, platelet count was 134,000 platelets/μL, hemoglobin value was 12.4 g/dL, and hematocrit was 37%. Folic acid 1 mg i.v. every six hours and leucovorin 10 mg/m² (20 mg) i.v. every six hours was initiated. His serum methotrexate concentration was 0.03 μmol/L on hospital day 6. The leucovorin dosage was increased to 200 mg i.v. every six hours. Platelets were administered, and the patient was switched to four-hour treatments of high-flux membrane hemodialysis for two consecutive days. The patient was discharged on hospital day 14. Mild mucositis was still present, but the patient had improved substantially and was discharged to a rehabilitation facility. Conclusion A 68-year-old peritoneal dialysis patient who was treated with 25 mg of intralesional methotrexate for squamous cell carcinoma of the hands developed pancytopenia, mucositis, and hepatotoxicity as a result of systemic absorption and prolonged elimination.

The purpose of this study was to evaluate the impact of a standardized reflection tool on the development of a teaching philosophy statement in a pharmacy residency teaching and learning curriculum program (RTLCP). Pharmacy residents participating in the RTLCP over a two-year period were surveyed using a pre/post method to assess perceptions of teaching philosophy development before and after using the tool. Responses were assessed using a 5-point Likert scale to indicate level of agreement with each statement. For analysis, responses were divided into high (strongly agree/agree) and low (neutral/disagree/strongly disagree) agreement. The level of agreement increased significantly for all items surveyed (p < 0.05), with the exception of one area pertaining to the ability to describe characteristics of outstanding teachers, which was noted to be strong before and after using the tool (p = 0.5027). Overall results were positive, with 81% of participants responding that the reflection tool was helpful in developing a teaching philosophy, and 96% responding that the resulting teaching philosophy statement fully reflected their views on teaching and learning. The standardized reflection tool developed at Shenandoah University assisted pharmacy residents enrolled in a teaching and learning curriculum program to draft a comprehensive teaching philosophy statement, and was well received by participants.