Toxic hepatitis due to combination therapy with methotrexate and etretinate in psoriasis

A case of toxic hepatitis caused by combination therapy with methotrexate and etretinate in the treatment of severe psoriasis is presented in a 47-year-old woman. The patient had received methotrexate alone for more than 10 years without any signs of severe liver damage. The liver status had been controlled by consecutive liver biopsies. The treatment was discontinued and after 2 months the liver parameters became normal.