Complete recovery of complicated methotrexate-induced liver cirrhosis in a patient with psoriasis: A case report

• Published in: Transplant immunology Vol. 70; p. 101492
• Main Authors: El Hage, Said, Akiki, Dany, El Masri, Jad, Roustom, Majd
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 01.02.2022
• Subjects: Humans; Immunology; Liver - pathology; Liver cirrhosis; Liver Cirrhosis - chemically induced; Liver Cirrhosis - complications; Liver Cirrhosis - drug therapy; Methotrexate; Methotrexate - adverse effects; Psoriasis; Psoriasis - complications; Psoriasis - drug therapy; Psoriasis - pathology; Immunology; Psoriasis; Methotrexate; Liver cirrhosis
• ISSN: 0966-3274; 1878-5492
• DOI: 10.1016/j.trim.2021.101492

Cirrhosis is the most common indication for liver transplant. Literature addressing methotrexate (MTX)-induced liver cirrhosis in patients with psoriasis is sparse. We present a case of a nonalcoholic patient diagnosed with psoriasis that was treated with a weekly 5 mg dose of methotrexate, a chemotherapeutic and immunological modulator, for five years. The patient presented after five years with abdominal distension and lower limb edema along with ascites and esophageal varices and was diagnosed with liver cirrhosis. Upon the discontinuation of MTX, the patient showed clear regression of ascites and esophageal varices, and recovery of liver cirrhosis by de-escalating from Child-Pugh B to A. After five years of follow-up, Echography and Transient Elastography (Fibroscan) of the liver confirmed the full recovery of liver cirrhosis by the absence of steatosis and fibrosis. This study emphasizes the reversibility of MTX-induced liver cirrhosis: cirrhosis is not aggressive, can be reversible, and is dose- and duration-dependent. •Cirrhosis has several causes, including drugs, and can lead to eventual liver transplantation.•Methotrexate (MTX) is an immunological modulator agent that is known to cause liver toxicity, rarely leading to cirrhosis.•We report a patient with psoriasis treated with MTX developing ascites, esophageal varices and cirrhosis.•Discontinuation of offending drug led to complete resolution of cirrhosis and other complications.•MTX-induced cirrhosis is less aggressive and dose and length-dependent.