When cure becomes a threat: A case series on methotrexate-induced liver injury in a tertiary care setting

Methotrexate, a cornerstone of modern therapeutics, is widely used as an immunosuppressant and anticancer agent. The occurrence of methotrexate-associated hepatotoxicity has been well documented. This case series highlights the spectrum of methotrexate-induced liver injury and emphasises the need for regular liver function monitoring to facilitate early detection and prevention of hepatotoxicity in patients receiving methotrexate therapy. This case series details have been collected from the outpatient department between the years 2019 and 2023 at a tertiary care teaching hospital. Causality assessment was performed using the World Health Organisation-Uppsala Monitoring Centre criteria. Methotrexate was prescribed for a duration ranging from 3 weeks to 4 years on a dose ranging from 2.5 mg to 25 mg once weekly. Among them, five were female and two were male, aged 19 years–70 years. Three patients already had renal involvement, and two more had diabetes. This case series reaffirms the principle that prevention is better than cure. It majorly emphasises the importance of routine liver monitoring in methotrexate patients to early detection and prevention of hepatotoxic effects.