To the Editor.—I read with interest the article by Moore et al1 in the January 2002 Archives entitled “Methotrexate-Related Nonnecrotizing Multifocal Axonopathy Detected by β-Amyloid Precursor Protein Immunohistochemistry.” I found the discussion of issues related to methotrexate toxicity and immunohistochemical diagnosis to be enlightening; however, I was puzzled by the reference to “hepatic granulomas consistent with chronic transfusion therapy” as part of the autopsy findings. When stated as such, the impression is that the finding and its interpretation are without question. However, it has not been my experience that chronic transfusion therapy has any relation to granulomatous disease of the liver or any other organ, nor could I find any reference to such in standard textbooks2,3 or the medical literature. Was this statement in error, or does some relationship exist between transfusion and granulomas of which I am unaware? Interestingly, methotrexate has been used successfully to treat idiopathic granulomatous hepatitis.4 

Moore
,
B. E.
,
N. P.
Somers
, and
T. W.
Smith
.
Methotrexate-related nonnecrotizing multifocal axonopathy detected by β-amyloid precursor protein immunohistochemistry.
Arch Pathol Lab Med
2002
.
126
:
79
81
.
Snover
,
D. C.
Nonneoplastic liver disease.
In: Sternberg SS. Diagnostic Surgical Pathology. Philadelphia, Pa: Lippincott Williams & Wilkins; 1999:1509
.
Reynolds
,
T. B.
,
J. L.
Campra
, and
R. L.
Peters
.
Granulomatous liver disease.
In: Zakim D, Boyer TD. Hepatology: A Textbook of Liver Disease. Philadelphia, Pa: WB Saunders & Co; 1996:1472
.
Knox
,
T. A.
,
N. M.
Kaplan
,
J. A.
Gelfand
, and
S. M.
Wolff
.
Methotrexate treatment of idiopathic granulomatous hepatitis.
Ann Intern Med
1995
.
123
:
733
.