Methotrexate-Induced Hepatic Injury in an Adult: A Case Report

In 1948 methotrexate, a folic acid antagonist, was introduced by Farber and his associates as a chemotherapeutic agent for the treatment of leukemia.1 Since that time many clinical and experimental studies have shown the folic acid antagonist to be of variable benefit in the treatment of a number of neoplasms,2-7 as well as the epidermal hyperplastic disorder, psoriasis.8The folic acid antagonists have produced undesirable side effects in many cases because of a narrow margin of safety between therapeutic and toxic dosages. Anemia, leukopenia, thrombocytopenia, stomatitis, and gastrointestinal ulcerations have been reported following this mode of therapy.1,2,4,9,10,12Skin rashes, alopecia, and erythrocytic macrocytosis with a megaloblastic bone marrow have also occurred.1,2,11,12A rare complication following treatment with folic acid antagonists is periportal fibrosis of the liver. In 1955 Colsky reported the occurrence of hepatic fibrosis in children with acute leukemia, following treatment with methotrexate.