Autoimmune hepatitis as an adverse effect of long-term methotrexate therapy

Area of Science:

• Hepatology
• Immunology
• Pharmacology

Background:

• Methotrexate (MTX) is a widely prescribed medication for psoriatic arthritis and other autoimmune conditions.
• Long-term MTX use is associated with potential liver toxicity, including steatosis and cirrhosis.
• Drug-induced autoimmune hepatitis is a recognized but uncommon adverse effect of MTX therapy.

Observation:

• A 53-year-old woman with a history of psoriatic arthritis developed autoimmune hepatitis.
• The patient had been undergoing long-term treatment with methotrexate for her condition.
• Hepatitis symptoms resolved completely within four months of discontinuing MTX.

Findings:

• This case highlights autoimmune hepatitis as a potential serious adverse event associated with long-term methotrexate use.
• The resolution of hepatitis after MTX cessation suggests a drug-induced etiology.
• The underlying mechanisms of drug-induced autoimmunity remain complex and require further investigation.

Implications:

• Clinicians should maintain a high index of suspicion for autoimmune hepatitis in patients on long-term MTX.
• Regular monitoring of liver enzymes is essential for early detection of MTX-induced hepatotoxicity.
• This case underscores the importance of vigilant patient management in rheumatology and dermatology practices.