A Rare Case of Methotrexate-Induced Gastric Ulcer

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.