Tempting liver fibrosis? Long-term psoriatic methotrexate therapy and heterozygous alpha1-antitrypsin deficiency.
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.
Mathew
Joseph
J
Department of Histopathology, Royal Cornwall Hospital, Truro, UK. joe.matthew@rcht.cornwall.nhs.uk
Igbokwe
Uchechi O
UO
Morley
Nick
N
Burt
Alastair D
AD
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*
D007166:Immunosuppressive Agents; D008727:Methotrexate