Methotrexate-Induced Apoptotic Colopathy in Crohn's Disease

Area of Science:

• Gastroenterology
• Pathology
• Pharmacology

Background:

• Apoptotic colopathy is an underrecognized pattern of colonic injury.
• Its association with Crohn's disease (CD) is infrequent, though it can be linked to medications used in CD management.
• Methotrexate is a common medication for managing CD.

Purpose of the Study:

• To report a case of apoptotic colopathy in a patient with Crohn's disease.
• To investigate the potential role of methotrexate in the development of apoptotic colopathy.
• To assess the impact of methotrexate discontinuation on apoptotic colopathy and CD symptoms.

Main Methods:

• A diagnostic colonoscopy was performed on a patient with CD presenting with abdominal pain and diarrhea.
• Biopsies were taken during colonoscopy to examine the colonic tissue.
• A follow-up colonoscopy was conducted after discontinuing methotrexate to evaluate changes.

Main Results:

• Biopsies from the initial colonoscopy revealed evidence of apoptotic colopathy.
• Following the discontinuation of methotrexate, the repeat colonoscopy showed resolution of apoptotic colopathy.
• The patient experienced improvement in diarrhea after stopping methotrexate.

Conclusions:

• Apoptotic colopathy can occur in Crohn's disease patients, potentially as a side effect of methotrexate.
• Discontinuation of methotrexate may lead to the resolution of apoptotic colopathy.
• This case highlights the importance of considering medication side effects in CD management.