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Asymptomatic colitis induced by low-dose methotrexate
  1. Toshikazu Ozeki,
  2. Yoshiro Fujita
  1. Chubu Rosai Hospital, Nagoya, Japan
  1. Correspondence to Dr Toshikazu Ozeki, ozeki.0312{at}


A woman aged 77 years with a history of rheumatoid arthritis (RA) presented with inflammatory colitis confined to her rectum, which was incidentally found by a screening colonoscopy. Histopathological examination of colonic biopsies showed non-specific inflammatory infiltrates of lymphocytes, the cause of which was unknown. She had been diagnosed with RA 5 years before, and she was receiving methotrexate 6 mg weekly, to which tocilizumab had been added 4 years earlier, which achieved stable control of her disease. She had no gastrointestinal symptoms or other health problems. Tocilizumab-induced colitis was considered likely, and the drug was discontinued. Metronidazole was also prescribed because of possible Clostridium difficile-associated colitis. 3 months later, a repeat colonoscopy showed no improvement of the colitis. The methotrexate was also discontinued, and folinic acid was prescribed daily for 2 weeks, leading to complete resolution of the colitis observed at repeat colonoscopy.

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  • Contributors TO drafted the article and revised it critically in cooperation with YF.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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