Methotrexate-Induced Hepatotoxicity in a Patient with a History of Alcohol Abuse: Case Report
Bibliographic record
Abstract
Methotrexate (MTX) is a widely used treatment for conditions such as rheumatoid arthritis and psoriasis. Although its potential for hepatotoxicity is known, there is limited research on how to prevent this adverse effect, and despite this risk, MTX continues to be frequently prescribed. We present the case of a 56-year-old male with a history of alcohol abuse who developed acute jaundice, malaise, and a positive Murphy’s sign after starting MTX therapy for inflammatory rheumatoid arthritis. The patient was advised to abstain from alcohol due to the shared hepatic first-pass metabolism of both alcohol and MTX, and although he successfully stopped heavy drinking, he continued to consume alcohol occasionally in small amounts. After one month of treatment, the patient developed symptomatic grade 2 hepatic steatosis, requiring emergent plasmapheresis. This case highlights the lack of data on the effects of MTX in patients with prior alcohol abuse and demonstrates how a brief period of MTX use can result in the progression of hepatotoxicity in patients with pre-existing liver damage.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.002 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.003 | 0.002 |
| Science and technology studies | 0.003 | 0.002 |
| Scholarly communication | 0.002 | 0.002 |
| Open science | 0.001 | 0.002 |
| Research integrity | 0.004 | 0.004 |
| Insufficient payload (model declined to judge) | 0.002 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".