title: Asymptomatic colitis induced by low-dose methotrexate.
abstract: A woman aged 77 years with a history of rheumatoid arthritis (RA) presented with inflammatory colitis confined to her rectum, which was incidentally found by a screening colonoscopy. Histopathological examination of colonic biopsies showed non-specific inflammatory infiltrates of lymphocytes, the cause of which was unknown. She had been diagnosed with RA 5 years before, and she was receiving methotrexate 6 mg weekly, to which tocilizumab had been added 4 years earlier, which achieved stable control of her disease. She had no gastrointestinal symptoms or other health problems. Tocilizumab-induced colitis was considered likely, and the drug was discontinued. Metronidazole was also prescribed because of possible Clostridium difficile-associated colitis. 3 months later, a repeat colonoscopy showed no improvement of the colitis. The methotrexate was also discontinued, and folinic acid was prescribed daily for 2 weeks, leading to complete resolution of the colitis observed at repeat colonoscopy.
authors.affiliation: Chubu Rosai Hospital, Nagoya, Japan.
authors.forename: Toshikazu
authors.initials: T
authors.lastname: Ozeki
authors.affiliation: Chubu Rosai Hospital, Nagoya, Japan.
authors.forename: Yoshiro
authors.initials: Y
authors.lastname: Fujita
mesh_terms: D000368:Aged; D000890:Anti-Infective Agents / Q000627:therapeutic use; D061067:Antibodies, Monoclonal, Humanized / Q000008:administration & dosage; D000931:Antidotes / Q000627:therapeutic use; D018501:Antirheumatic Agents / Q000008:administration & dosage / Q000009:adverse effects*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D003092:Colitis / Q000139:chemically induced* / Q000188:drug therapy; D003113:Colonoscopy; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D033162:Incidental Findings; D002955:Leucovorin / Q000627:therapeutic use; D008727:Methotrexate / Q000008:administration & dosage / Q000009:adverse effects*; D008795:Metronidazole / Q000627:therapeutic use
chemical_list: D000890:Anti-Infective Agents; D061067:Antibodies, Monoclonal, Humanized; D000931:Antidotes; D018501:Antirheumatic Agents; D008795:Metronidazole; C502936:tocilizumab; D002955:Leucovorin; D008727:Methotrexate