title: Tempting liver fibrosis? Long-term psoriatic methotrexate therapy and heterozygous alpha1-antitrypsin deficiency.
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 alpha(1)-antitrypsin deficiency.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Histopathology, Royal Cornwall Hospital, Truro, UK. joe.matthew@rcht.cornwall.nhs.uk
authors.forename: Joseph
authors.initials: J
authors.lastname: Mathew
authors.forename: Uchechi O
authors.initials: UO
authors.lastname: Igbokwe
authors.forename: Nick
authors.initials: N
authors.lastname: Morley
authors.forename: Alastair D
authors.initials: AD
authors.lastname: Burt
mesh_terms: D000368:Aged; D001706:Biopsy; D005500:Follow-Up Studies; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D008103:Liver Cirrhosis / Q000097:blood / Q000150:complications* / Q000473:pathology; D008297:Male; D008727:Methotrexate / Q000627:therapeutic use*; D011565:Psoriasis / Q000150:complications / Q000188:drug therapy*; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D019896:alpha 1-Antitrypsin Deficiency / Q000097:blood / Q000150:complications*
chemical_list: D007166:Immunosuppressive Agents; D008727:Methotrexate