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A Case of Diverticular Perforation in a Young Patient with Rheumatoid Arthritis on Methotrexate

Ian Chang1, Carla Guggenheim2, Heather Laird-Fick1

  • 1Department of Medicine, Michigan State University, East Lansing, MI 48824, USA ; EW Sparrow Hospital, Lansing, MI 48912, USA.

Case Reports in Medicine
|June 12, 2015
PubMed

Insights

This case study explores a patient with rheumatoid arthritis experiencing sigmoid diverticular perforation while on methotrexate. It investigates the potential link between methylenetetrahydrofolate reductase (MTHFR) gene variations and drug toxicity.

Area of Science:

  • Rheumatology
  • Pharmacogenomics
  • Gastroenterology

Background:

  • Disease-modifying antirheumatic drugs (DMARDs), including methotrexate (MTX), can cause gastrointestinal toxicity.
  • Methotrexate inhibits dihydrofolate reductase, but its association with methylenetetrahydrofolate reductase (MTHFR) gene polymorphisms and toxicity is not well understood.

Purpose of the Study:

  • To report a case of sigmoid diverticular perforation in a patient with rheumatoid arthritis treated with methotrexate.
  • To explore the potential role of MTHFR gene polymorphisms in methotrexate-related gastrointestinal toxicity.

Main Methods:

  • Case report of a 33-year-old male with polyarticular rheumatoid arthritis.
  • Genetic testing for MTHFR gene polymorphisms (C677T allele).
  • Review of patient's medication regimen including methotrexate, folic acid, prednisone, and naproxen.

Main Results:

  • The patient developed sigmoid diverticular perforation while on methotrexate and other medications.
  • The patient was heterozygous for the C677T MTHFR gene allele.
  • Concomitant use of NSAIDs, nonbiologic DMARDs, and glucocorticoids may increase perforation risk.

Conclusions:

  • Rheumatoid arthritis and its treatments increase the risk of gastrointestinal complications.
  • The association between MTHFR gene mutations and MTX toxicity requires further investigation.
  • This case contributes to understanding potential risk factors for severe gastrointestinal events in patients treated with MTX.

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