Lack of Monitoring During Psoriasis Treatment Leads to Liver Damage

Case Overview

This case takes place in Michigan and involves an older male patient who suffered from complications after prolonged use of a particular drug. The patient had been treated with the drug for several years in order to treat persistent psoriasis that had proven resistant to other treatments. He ended up being hospitalized for jaundice after taking the drug for several years. Blood tests were done occasionally during the course of the patient’s treatment- some of which showed changes in patient’s liver enzymes in the time leading up to his hospitalisation. Despite these findings, the plaintiff was never taken off the medication. As a result, he suffered extensive liver damage and is now unable to take any medication. It is alleged that defendant did not take the necessary steps to prevent liver damage after reviewing the patient’s blood work.

Questions to the Hepatology expert and their responses

Do you have knowledge of the complications that can occur when a patient is kept on this drug?

Methotrexate in high enough cumulative doses has been shown to precipitate fatty liver disease fibrosis and cirrhosis of the liver. Patients can also have acute changes in aminotransferase levels with administration of methotrexate, although these reactions tend to be more idiosyncratic.

What are the necessary steps when a client shows elevated liver enzymes?

A work-up should be initiated including blood testing, liver imaging and if necessary a liver biopsy. Any offending agents should be stopped (drugs, alcohol, herbals).

Do you have experience working on similar cases?

I have no experience reviewing cases in the past.

About the expert

This expert has extensive experience in the field of hepatology and liver transplantation. He earned his BS from the University of Maryland College Park, his MS from Northwestern University, and his MD from the University of Virginia School of Medicine. He completed his residency in internal medicine and two fellowships in gastroenterology, hepatology, and nutrition and transplant hepatology at Northwestern University. Today, this expert is board certified in gastroenterology and transplant hepatology and is a member of the American Association for the Study of Liver Disease and the International Liver Cancer Association. He previously served as a clinical lecturer in the department of gastroenterology and hepatology at the University of Michigan. Currently, he is a staff physician and the co-director of the liver tumor program at a VA medical center in Michigan. In addition, he is an assistant professor of gastroenterology and hepatology and the medical director of both the living donor liver transplant program and the liver tumor program at a medical school in Michigan.