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 alpha(1)-antitrypsin deficiency.
Case presentation: We relate our experience with an elderly male patient, diagnosed as having alpha(1)-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 alpha(1)-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, Basel.