Fatal bacterial endocarditis following aortic valve replacement in a patient being treated with methotrexate

A 41-year-old man being treated with methotrexate for psoriasis underwent aortic valve replacement. He subsequently developed fulminating bacterial endocarditis. Bacterial endocarditis occurs in 1-2% of cases after prosthetic valve replacement and has a high mortality. The long-term use of methotrexate and similar drugs is increasing in conditions such as psoriasis, rheumatoid arthritis and inflammatory bowel disease. Thus, more patients undergoing heart valve surgery will be taking these preparations for coexisting disease. As methotrexate increases the risk of infection, its perioperative use in these patients requires further evaluation.