Non-coeliac sprue possibly related to methotrexate in a rheumatoid arthritis patient

We describe a case of non-coeliac sprue in a low-dose methotrexate treated patient suffering from rheumatoid arthritis. This is the first case report of this possibly reversible complication of methotrexate therapy. The diagnosis was confirmed by a duodenal mucosal biopsy revealing the characteristic intestinal histopathology of coeliac sprue. After discontinuation of the drug a repeat biopsy was almost normal, and completely normal after reintroduction of a normal diet. One could speculate about the methotrexate related mechanism of the villous atrophy: it might be either a direct toxic effect or a secondary effect of the immunosuppression.