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Methotrexate/naproxen-associated severe hepatitis in a child with juvenile idiopathic arthritis

T V Ting1, P J Hashkes

  • 1Section of Pediatric Rheumatology, Department of Rheumatic Diseases, Cleveland Clinic Foundation, Cleveland, OH 44195, USA.

Clinical and Experimental Rheumatology
|January 5, 2008
PubMed

Insights

Methotrexate (MTX) is generally safe for juvenile idiopathic arthritis (JIA), but rare cases of severe liver toxicity can occur. This study highlights a case of MTX and naproxen-induced liver injury in a child with JIA.

Area of Science:

  • Pediatric Rheumatology
  • Hepatology
  • Clinical Toxicology

Background:

  • Methotrexate (MTX) is a primary treatment for juvenile idiopathic arthritis (JIA).
  • While generally safe, MTX can cause liver enzyme abnormalities in JIA patients.
  • Severe liver damage is rare in non-systemic JIA.

Observation:

  • A 2-year-old girl with oligoarticular JIA developed severe liver enzyme elevation, hypoglycemia, and hyperammonemia.
  • These symptoms emerged after 10 months of concurrent MTX and naproxen therapy.
  • Other potential causes were ruled out through comprehensive infectious and metabolic work-ups.

Findings:

  • The patient experienced liver enzyme levels over 45 times the normal limit.
  • Complete recovery was achieved with folinic acid treatment.
  • MTX and naproxen were discontinued and not resumed.

Implications:

  • This case underscores the rare but significant risk of severe hepatotoxicity from the combination of MTX and naproxen in JIA.
  • It emphasizes the critical importance of vigilant monitoring for liver enzyme abnormalities in children receiving MTX therapy.
  • Prompt recognition and intervention with folinic acid can lead to full recovery.

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