Innovative approach on monitoring methotrexate-induced hepatotoxicity in psoriasis patients:  a case report

Ana-Maria Sandu; Oana Mirela Tiucă; Radu Stan; Adina-Maria Andone; Robert Aurelian Tiucă; Ovidiu Simion Cotoi; Silviu Horia Morariu

doi:10.2478/amma-2025-0034

Ana-Maria Sandu Dermatology Department, Mureș County Hospital, Târgu Mureș, România
Oana Mirela Tiucă Dermatology Department, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Târgu Mureș, România
Radu Stan Dermatology Department, Mureș County Hospital, Târgu Mureș, România
Adina-Maria Andone Internal Medicine Department, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Târgu Mureș, România
Robert Aurelian Tiucă Endocrinology Department, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Târgu Mureș, România
Ovidiu Simion Cotoi Pathophysiology Department, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Târgu Mureș, România
Silviu Horia Morariu Dermatology Department, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Târgu Mureș, România

DOI: https://doi.org/10.2478/amma-2025-0034

Keywords: methotrexate, psoriasis, hepatotoxicity, FIB-4

Abstract

Introduction: Methotrexate is often used as the first line of systemic treatment in patients with moderate to severe psoriasis and psoriatic arthritis. Case report: We present the case of a 44-year-old male patient with moderate plaque psoriasis who was treated with methotrexate and was diagnosed with mild hepatic steatosis during the first month of treatment. Using FIB-4 (Fibrosis Index Based on 4 factors) as a noninvasive method for assessing the risk of liver fibrosis, the patient was able to take methotrexate safely, with close monitoring of liver function. Conclusions: FIB-4 can be used to assess the risk of liver fibrosis in psoriasis patients treated with methotrexate to ensure better adherence to the treatment.