Innovative approach on monitoring methotrexate induced hepatotoxicity in psoriasis patients – A case report

Ana-Maria Sandu¹, Oana Mirela Tiucă², Radu Stan¹, Adina-Maria Andone³, Robert Aurelian Tiucă⁴, Ovidiu Simion Cotoi⁵, Silviu Horia Morariu²

1. Dermatology Department, Mures County Hospital, Targu Mures, Romania
2. Dermatology Department, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
3. Gastroenterology Department, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
4. Endocrinology Department, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
5. Pathophysiology Department, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania

DOI: 10.2478/amma-2025-0034

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 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.