Methotrexate-Induced Hepatotoxicity in a Patient with a History of Alcohol Abuse: Case Report
DOI:
https://doi.org/10.52609/jmlph.v6i1.223Keywords:
Alcohol-Related Disorders, Arthritis, Drug-Induced Liver Injury, Liver Failure, Methotrexate, RheumatoidAbstract
Methotrexate (MTX) is a widely used treatment for conditions such as rheumatoid arthritis and psoriasis. Although its potential for hepatotoxicity is known, there is limited research on how to prevent this adverse effect, and despite this risk, MTX continues to be frequently prescribed. We present the case of a 56-year-old male with a history of alcohol abuse who developed acute jaundice, malaise, and a positive Murphy’s sign after starting MTX therapy for inflammatory rheumatoid arthritis. The patient was advised to abstain from alcohol due to the shared hepatic first-pass metabolism of both alcohol and MTX, and although he successfully stopped heavy drinking, he continued to consume alcohol occasionally in small amounts. After one month of treatment, the patient developed symptomatic grade 2 hepatic steatosis, requiring emergent plasmapheresis. This case highlights the lack of data on the effects of MTX in patients with prior alcohol abuse and demonstrates how a brief period of MTX use can result in the progression of hepatotoxicity in patients with pre-existing liver damage.
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Copyright (c) 2025 Fatih Kaya, Mohammad Jamal Abunawas, Manar Al-Suleh, Ghayda Jarrar, Yare Sahin
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