title: Successful treatment of refractory type 1 autoimmune hepatitis with methotrexate.
abstract: OBJECTIVE
  Autoimmune hepatitis is a heterogeneous disorder that typically responds to glucocorticoids with or without azathioprine. Treatment options for patients not responding to standard therapy are limited.
  
  
  METHODS
  We describe a 52-year-old female who presented with jaundice, marked elevation in liver enzymes, positive antinuclear antibody and a liver biopsy consistent with autoimmune hepatitis. Liver enzymes did not normalize with prednisone alone. When azathioprine was added, the disease flared. The patient refused cyclosporine. Methotrexate 7.5 mg po per week resulted in normalization of liver enzymes, improved liver histology, and has maintained remission with a steroid-sparing effect.
  
  
  CONCLUSIONS
  In this patient methotrexate was used successfully to treat type 1 autoimmune hepatitis. This suggests that methotrexate may have a role in treatment of autoimmune hepatitis refractory to standard therapy.
authors.affiliation: Department of Medicine, University of Calgary, Alberta, Canada.
authors.forename: K W
authors.initials: KW
authors.lastname: Burak
authors.forename: S J
authors.initials: SJ
authors.lastname: Urbanski
authors.forename: M G
authors.initials: MG
authors.lastname: Swain
mesh_terms: D005260:Female; D019693:Hepatitis, Autoimmune / Q000188:drug therapy*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D008727:Methotrexate / Q000627:therapeutic use*; D008875:Middle Aged; D016896:Treatment Outcome
chemical_list: D007166:Immunosuppressive Agents; D008727:Methotrexate