How would you approach a patient with high CRP, rising liver enzymes and new biopsy proven liver granulomas 6 months after starting methotrexate and Rituximab therapy for ANCA vasculitis?

Could the new liver granulomas due to MTX Hepato toxicity?

Answer from: at Academic Institution

What does the liver biopsy show in detail? I'd be far more worried about infection than AAV. Sarcoid could also present this way. How did they get the AAV diagnosis?

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at Duke University Medical Center
Agree! Hepatic involvement seems quite unusual for...

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How would you approach a patient with high CRP, rising liver enzymes and new biopsy proven liver granulomas 6 months after starting methotrexate and Rituximab therapy for ANCA vasculitis?

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