“Drug – induced” or “medication- related” forms of enteropathy are known to result in alterations in small intestinal architecture and function causing “sprue- like” mucosal changes, diarrhoea and malabsorption. Many drugs are proved to induce these changes and these include chemotherapeutic agents like colchicine, vincristine, and immunosuppresants like methotrexate, azathioprine, mycophenolate mofetil [1]. Several cases of villous atrophy following use of immunosuppresants are reported. But, literature search revealed only two cases of intestinal villous atrophy secondary to methotrexate [2]. We present this third case of sprue- like syndrome secondary to methotrexate treatment in a psoriatic patient