A liver fibrosis cocktail? Psoriasis, methotrexate and genetic hemochromatosis.
BACKGROUND
Pathologists are often faced with the dilemma of whether to recommend continuation of methotrexate therapy for psoriasis within the context of an existing pro-fibrogenic risk factor, in this instance, patients with genetic hemochromatosis.


METHODS
We describe our experience with two male psoriatic patients (A and B) on long term methotrexate therapy (cumulative dose A = 1.56 gms and B = 7.88 gms) with hetero- (A) and homozygous (B) genetic hemochromatosis. These patients liver function were monitored with routine biochemical profiling; apart from mild perivenular fibrosis in one patient (B), significant liver fibrosis was not identified in either patient with multiple interval percutaneous liver biopsies; in the latter instance this patient (B) had an additional risk factor of partiality to alcohol.


CONCLUSIONS
We conclude that methotrexate therapy is relatively safe in patients with genetic hemochromatosis, with no other risk factor, but caution that the risk of fibrosis be monitored, preferably by non-invasive techniques, or by liver biopsy.
Mathew
Joseph
J
Department of Histopathology, Royal Cornwall Hospital, Truro, TR1 3 LJ, UK. joe.mathew@rcht.cornwall.nhs.uk
Leong
May Y
MY
Morley
Nick
N
Burt
Alastair D
AD
D003879:Dermatologic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D005234:Fatty Liver / Q000139:chemically induced / Q000175:diagnosis; D005355:Fibrosis / Q000209:etiology; D006432:Hemochromatosis / Q000150:complications*; D006801:Humans; D008099:Liver / Q000473:pathology*; D008297:Male; D008727:Methotrexate / Q000009:adverse effects / Q000627:therapeutic use*; D008875:Middle Aged; D011565:Psoriasis / Q000150:complications / Q000188:drug therapy*; D012307:Risk Factors
D003879:Dermatologic Agents; D008727:Methotrexate