Abstract

Methotrexate (MTX) is a folate antagonist which damages the DNA and classified as an antimetabolite antineoplastic agent. It is the most commonly used drug in the treatment of rheumatoid arthritis (RA) and its efficiency and reliability were well established. Drug-induced hepatotoxicity varies from non-specific liver changes to acute fulminant failure, cirrhosis and liver cancer. The mechanism in which methotrexate causes liver damage is not known. It may cause acute increase in transaminase enzymes, and on the long-term it may lead to liver fibrosis and cirrhosis. Whether it is used in high doses (eg, cyclic use of 1 gram or more) or on low doses (eg, weekly doses of 7.5 to 25 mg), MTX may lead to life threatening conditions like hepatotoxicity. Presented in this case report, a 52 year old male patient was diagnosed with rheumatoid arthritis. in which hepatic fibrosis and prolonged cholestatic liver disease occurred secondary to prolonged usage of MTX

Key words: Methotrexate, liver disease, cholestasis