Methotrexate-Induced Mucositis in a Patient with Angioimmunoblastic T-cell Lymphoma

To the Editor: Angioimmunoblastic T-cell lymphoma (AITL) is an uncommon peripheral T-cell lymphoma that accounts for 1% to 2% of all forms of non-Hodgkin lymphoma and usually affects middle-aged individuals. 1It primarily appears on the skin and mimics an inflammatory dermatosis, leading to diagnostic and therapeutic delays. 2 No gold-standard treatment has been identified for AITL; the prognosis often remains poor, with a 5-year progressionfree survival rate of approximately 25%. 3 Because of the rarity of AITL and the unmet need of a standard-of-care treatment regimen, relapsing and remitting disease is common and continues to challenge clinicians.Methotrexate (MTX), a dihydrofolate reductase inhibitor used to treat many autoimmune diseases, is prescribed at a higher dosage (>500 mg/m 2 ) to manage cancers, including refractory AITL. 4 In blocking dihydrofolate