Methotrexate (MTX) is currently under study for use in juvenile rheumatoid 
arthritis. One complication of MTX is hepatotoxicity. Although liver function 
tests may be abnormal with its use, in this setting they do not correlate well 
with the development of hepatic fibrosis. Periodic liver biopsy is required to 
monitor for the hepatotoxic changes secondary to MTX. We describe and discuss 
the case of a 17-year-old woman who developed evidence of hepatic fibrosis after 
3 years of MTX therapy.