Methotrexate (MTX) is the most widely used slow-acting anti-rheumatic agent in the treatment of rheumatoid arthritis. But, long-term administration of MTX can be complicated with liver fibrosis and even cirrhosis. We report the case in elderly woman with healthy Hepatitis B viral carrier patient who developed liver cirrhosis without viral replication after low-dose MTX therapy for rheumatoid arthritis.