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Tempting liver fibrosis? Long-term psoriatic methotrexate therapy and heterozygous α1-antitrypsin deficiency

Lookup NU author(s): Professor Alastair BurtORCiD

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Abstract

Background: Dermatologists, or pathologists, occasionally need to decide whether or not to continue methotrexate therapy in a patient with an identifiable risk factor for liver fibrosis, in this instance heterozygous α1-antitrypsin deficiency. Case Presentation: We relate our experience with an elderly male patient, diagnosed as having α1-antitrypsin deficiency on a liver biopsy, genotypically confirmed as PiMZ. He had been receiving methotrexate for psoriasis for 17 years with a cumulative dose of 7,200 mg. He was monitored by biochemical profiling and interval (10) liver biopsies. Non-specific changes were seen on liver histology although grade 1 liver fibrosis was seen in his last 2 biopsies. Conclusion: We suggest that methotrexate therapy is relatively safe in patients with heterozygous α1-antitrypsin deficiency, with no other risk factor. We however advise that the risk of fibrosis should be monitored and that the patient receives appropriate counselling. Copyright © 2006 S. Karger AG.

Publication metadata

Author(s): Mathew J, Igbokwe UO, Morley N, Burt AD

Publication type: Article

Publication status: Published

Journal: Dermatology

Year: 2006

Volume: 213

Issue: 2

Pages: 147-149

ISSN (print): 1018-8665

ISSN (electronic): 1421-9832

Publisher: S. Karger AG

URL: http://dx.doi.org/10.1159/000093855

DOI: 10.1159/000093855

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