Successful treatment of refractory type 1 autoimmune hepatitis with methotrexate

Background/Aims: Autoimmune hepatitis is a heterogeneous disorder that typi cally responds to glucocorticoids with or without azathioprine. Treatment o ptions for patients not responding to standard therapy are limited. Methods: We describe a 52-year-old female who presented with jaundice, mark ed elevation in liver enzymes, positive antinuclear antibody and a liver bi opsy consistent with autoimmune hepatitis. Liver enzymes did not normalize with prednisone alone. When azathioprine was added, the disease flared. The patient refused cyclosporine. Methotrexate 7.5 mg po per week resulted in normalization of liver enzymes, improved liver histology, and has maintaine d remission with a steroid-sparing effect. Results/Conclusion: In this patient methotrexate was used successfully to t reat type 1 autoimmune hepatitis. This suggests that methotrexate may have a role in treatment of autoimmune hepatitis refractory to standard therapy.