Non-coeliac sprue possibly related to methotrexate in a rheumatoid arthritis patient
Houtman, P.M.; Hofstra, S.S.; Spoelstra, P.
Netherlands Journal of Medicine 47(3): 113-116
1995
ISSN/ISBN: 0300-2977 PMID: 7566289 Document Number: 452667
We describe a case of non-coeliac sprue in a low-dose methotrexate treated patient suffering from rheumatoid arthritis. This is the first case report of this possibly reversible complication of methotrexate therapy. The diagnosis was confirmed by a duodenal mucosal biopsy revealing the characteristic intestinal histopathology of coeliac sprue. After discontinuation of the drug a repeat biopsy was almost normal, and completely normal after reintroduction of a normal diet. One could speculate about the methotrexate related mechanism of the villous atrophy: it might be either a direct toxic effect or a secondary effect of the immunosuppression.