Case Report
Copyright ©2008 The WJG Press and Baishideng. All rights reserved.
World J Gastroenterol. Dec 7, 2008; 14(45): 7009-7011
Published online Dec 7, 2008. doi: 10.3748/wjg.14.7009
Methotrexate induced sprue-like syndrome
Marta Maia Boscá, Ramon Añón, Empar Mayordomo, Rosana Villagrasa, Nelly Balza, Cirilo Amorós, Juan Ramon Corts, Adolfo Benages
Marta Maia Boscá, Ramon Añón, Rosana Villagrasa, Nelly Balza, Cirilo Amorós, Adolfo Benages, Gastroenterology Department, Hospital Clínic Universitari of València, Spain
Empar Mayordomo, Department of Anathomo-Pathology, Hospital Clínic Universitari of València, Spain
Juan Ramon Corts, Rheumatology Department, Hospital Clínic Universitari of València, Spain
Author contributions: Benages A supervised the article, Añón R, Bosca MM and Corts JR visited the patient, Mayordomo E reviewed the anathomopathology, Villagrasa R and Balza N reviewed the patients’ story and researched the published papers for similar cases, and Amorós C and Boscá MM wrote the case report.
Correspondence to: Marta Maia Boscá, Gastroenterology Department, Hospital Clínic Universitari of València, Universitat de València Avda. Blasco Ibanez 17 46010 Valencia, Spain. maiabosca@yahoo.es
Telephone: +34-96-3862600-51255 Fax: +34-96-3864767
Received: February 3, 2008
Revised: November 7, 2008
Accepted: November 14, 2008
Published online: December 7, 2008
Abstract

A 52 year-old male patient diagnosed of ankylosing spondylitis presented with an iron deficiency anemia after a ten-month treatment of methotrexate. He did not respond to treatment with oral iron not a proton pump inhibitor and an upper endoscopy was performed. The histological study of the duodenal biopsies showed villus atrophy. After removing the methotrexate, administrating intramuscular iron and undertaking a gluten-free diet, the histological and analytical alterations progressively resolved.

Keywords: Methotrexate; Villous atrophy; Iron deficiency anemia; Paucisymptomatic; Absence of celiac antibodies