Methotrexate induced chronic hepatotoxicity

Hemalatha Thiyagarajan, Seema P. Mohamed Ali, Karunai Kadhir Veluchamy


55 year old male patient diagnosed to have psoriasis 2.5 years ago and was started on methotrexate 5 mg thrice weekly. Patient was symptomatically better and continued methotrexate without proper follow up. 2 months ago patient experienced abdominal pain and distension. Skin lesions worsened on discontinuing methotrexate but later subsided with treatment. 1 week ago, patient had abdominal pain, bleeding and ascites. Cumulative dose of methotrexate 1.8g; Liver function tests: total bilirubin- 2.0; direct - 1.0; platelet count: 58,000 cells/; ascitic tap done and fresh frozen plasma was infused.


Methotrexate, Hepatotoxicity, Psoriasis

Full Text:



Shen SO, Brien T, Yap LM, Prince HM, McCormack CJ. The use of methotrexate in dermatology: a review. Australas J Dermatol. 2012;53(1):1-18.

Berends MA, Snoek J, de Jong EM, van de Kerkhof PC, van Oijen MG, van Krieken JH, et al. Liver injury in long-term methotrexate treatment in psoriasis is relatively infrequent. Aliment Pharmacol Ther. 2006;24(5):805-11.

Nyfors A. Liver biopsies from psoriatics related to methotrexate therapy. Findings in post-methotrexate liver biopsies from 160 psoriatics. Acta Pathol Microbiol Scand. 1977;85:511-8.

Roenigk HH, Maibach HI, Weinstein GP. Methotrexate therapy for psoriasis. Guideline revisions. Arch Dermatol. 1973;108:35.

Campbell MS, Reddy KR. Review article: the evolving role of liver biopsy. Aliment Pharmacol Ther. 2004;20:249-59.