A Rare Case of Methotrexate-Induced Gastric Ulcer

Kyaw Min Tun; Tooba Laeeq; Salman Mohammed; Katrina Naik; Gordon Ohning

doi:10.7759/cureus.36321

A Rare Case of Methotrexate-Induced Gastric Ulcer

Cureus. 2023 Mar 17;15(3):e36321. doi: 10.7759/cureus.36321. eCollection 2023 Mar.

Authors

Kyaw Min Tun¹, Tooba Laeeq¹, Salman Mohammed¹, Katrina Naik², Gordon Ohning²

Affiliations

¹ Department of Internal Medicine, Kirk Kerkorian School of Medicine at the University of Nevada Las Vegas (UNLV), Las Vegas, USA.
² Division of Gastroenterology and Hepatology, Department of Internal Medicine, Kirk Kerkorian School of Medicine at the University of Nevada Las Vegas (UNLV), Las Vegas, USA.

Abstract

Methotrexate is commonly used to treat autoimmune conditions and malignancy. Peptic ulcer disease is a sparsely documented side effect of methotrexate. A 70-year-old female patient with rheumatoid arthritis on methotrexate presented with generalized fatigue and was found to be anemic. Endoscopy revealed gastric ulcers, the etiology of which was attributed to methotrexate use after careful exclusion of other possible causes. Cessation of methotrexate has been reported in the literature as vital to the healing of ulcers. Proton pump inhibitors or histamine 2 receptor (H2R) blockers may also be used as treatment; however, methotrexate should be discontinued before initiation of proton pump inhibitors, which can hinder the metabolism of methotrexate and can, in turn, lead to a worsening of the peptic ulcer disease.

Keywords: methotrexate; peptic ulcer disease; proton pump inhibitor; rheumatoid arthritis; side effect.

Publication types

Case Reports