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Primary Sclerosing Cholangitis and Low-Dose Oral Pulse Methotrexate Therapy: Clinical and Histologic Response

MARSHALL M. KAPLAN, M.D.; SANJEEV ARORA, M.D.; and STEPHANIE H. PINCUS, M.D.
[+] Article and Author Information

▸Requests for reprints should be addressed to Marshall M. Kaplan, M.D.; Gastroenterology Division, Box 233, New England Medical Center Hospitals, 750 Washington Street; Boston, MA 02111.


Boston, Massachusetts


©1987 American College of PhysiciansAmerican College of Physicians


Ann Intern Med. 1987;106(2):231-235. doi:10.7326/0003-4819-106-2-231
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Two patients with sclerosing cholangitis responded to low-dose methotrexate treatment. A 40-year-old man who had previously undergone total colectomy for ulcerative colitis presented with refractory erythroderma and sclerosing cholangitis. Both disorders were alleviated and have remained in remission on methotrexate, 5 mg every 12 hours three times each week (15 mg/wk). Liver function improved, bile duct scarring did not worsen, and repeat liver biopsy samples have shown striking improvement. A 60-year-old man with long-standing ulcerative colitis and repeated exacerbations of sclerosing cholangitis had a similar response to low-dose methotrexate, 2.5 mg every 12 hours three times each week (7.5 mg/wk), during a 6-year period. Recurrent episodes of cholangitis have disappeared, liver function has become normal, bile duct scarring has not worsened, and liver histologic findings have become normal. Because of the potential hepatotoxicity of methotrexate, we suggest that a prospective, randomized trial be done.

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