• Masayuki Miyata, Sho Ishiwata, Masahito Kuroda, Kazuhiro Tasaki, Kiyoshi Migita, and Hiromasa Ohira.
• Center for Rheumatology and Collagen Diseases, Fukushima Red Cross Hospital, Fukushima, Japan.
• Medicine (Baltimore). 2023 Jan 27; 102 (4): e32711e32711.

IntroductionChronic liver damage from methotrexate (MTX) is not uncommon, and fatal outcome is rare. We experienced a case of hepatic failure leading to death. We considered the cause of death through this case and proposed a method to prevent the progression of this liver injury.Patient ConcernsWe report the case of a patient with rheumatoid arthritis treated with MTX for 15 years.Diagnosis, Interventions, And OutcomesA liver biopsy revealed histological changes similar to those of advanced nonalcoholic steatohepatitis (NASH), most likely induced by MTX. MTX was discontinued after 4 years. Two years after the discontinuation, the patient died of irreversible hepatic failure. Her obesity, complicated by type 2 diabetes mellitus, might have aggravated MTX-induced NASH-like liver injury.ConclusionEarly diagnosis and immediate MTX discontinuation following NASH diagnosis and strict type 2 diabetes mellitus control might have prevented the irreversible progression of liver injury.Copyright © 2023 the Author(s). Published by Wolters Kluwer Health, Inc.

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