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Case Reports in Medicine
Volume 2015, Article ID 617268, 2 pages
Case Report

A Case of Diverticular Perforation in a Young Patient with Rheumatoid Arthritis on Methotrexate

1Department of Medicine, Michigan State University, East Lansing, MI 48824, USA
2EW Sparrow Hospital, Lansing, MI 48912, USA
3Arthritis Care, PC, Lansing, MI 48906, USA

Received 21 January 2015; Accepted 14 April 2015

Academic Editor: Remo Panaccione

Copyright © 2015 Ian Chang et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Background. Disease-modifying antirheumatic drugs (DMARDs), such as methotrexate (MTX), are associated with gastrointestinal toxicity. MTX inhibits dihydrofolate reductase, but it is unclear if polymorphisms of the methylenetetrahydrofolate reductase (MTHFR) gene predict toxicity. Case. We describe a 33-year-old male with polyarticular rheumatoid arthritis who developed sigmoid diverticular perforation while receiving methotrexate, folic acid, prednisone, and naproxen. He tested heterozygous for the C677T allele MTHFR gene. Discussion. Rheumatoid arthritis and its treatments are associated with increased risk of gastrointestinal disease. In one study, perforation was highest among individuals with concomitant exposure to NSAIDs, nonbiologic DMARDs, and glucocorticoids. Multiple mutations of the MTHFR gene have been identified, but their association with MTX toxicity is unclear. This case adds to a growing body of literature that could help inform the treatment of others in the future.