Document Detail

Methotrexate pneumonia lacking dyspnea and radiographic interstitial patterns during treatment for early rheumatoid arthritis: bronchoalveolar lavage and transbronchial lung biopsy in a differential diagnosis.
MedLine Citation:
PMID:  17564786     Owner:  NLM     Status:  MEDLINE    
Methotrexate (MTX) pneumonia is an unpredictable and sometimes life-threatening adverse effect occurring in the treatment of rheumatoid arthritis (RA). We present a case of MTX pneumonia lacking severe respiratory symptoms and typical radiographic findings. A 66-year-old man with early RA presented with intermittent fever and nonproductive cough during the MTX therapy, but neither hypoxemia nor dyspnea was a complaint. His chest X-ray films revealed multiple bilateral consolidations, but interstitial infiltrates were not observed. High-resolution computed tomography showed no ground-glass opacities. In contrast, the histological findings of transbronchial lung biopsy (TBLB) samples were characterized by the interstitial infiltration of mononuclear cells and hyperplasia of type II alveolar cells, which are the main features of drug-induced interstitial inflammation. Special stains for microorganisms were negative for the TBLB samples. Although cultures of bronchoalveolar lavage (BAL) fluids were slightly positive for Haemophilus influenzae, intensive antibiotic therapy was ineffective. A discontinuation of MTX followed by steroid therapy induced the patient's dramatic recovery. A new treatment with tacrolimus was started for RA. We would like to emphasize that the histological examinations and microbiological studies using BAL and TBLB are useful for the exclusion of other causes and the diagnosis of MTX pneumonia, especially in a case without typical respiratory symptoms and radiographic patterns.
Isamu Cho; Shunsuke Mori; Fumiya Imamura; Chikage Kiyofuji; Mineharu Sugimoto
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Publication Detail:
Type:  Case Reports; Journal Article     Date:  2007-06-20
Journal Detail:
Title:  Modern rheumatology / the Japan Rheumatism Association     Volume:  17     ISSN:  1439-7595     ISO Abbreviation:  Mod Rheumatol     Publication Date:  2007  
Date Detail:
Created Date:  2007-06-13     Completed Date:  2007-08-16     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  100959226     Medline TA:  Mod Rheumatol     Country:  Japan    
Other Details:
Languages:  eng     Pagination:  256-61     Citation Subset:  IM    
Clinical Research Center for Rheumatic Disease and Division of Respiratory Medicine, Department of Medicine, Kumamoto Saishunsou National Hospital, Kumamoto, Japan.
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MeSH Terms
Arthritis, Rheumatoid / drug therapy
Biopsy, Needle
Bronchoalveolar Lavage Fluid
Cough / etiology
Diagnosis, Differential
Immunosuppressive Agents / adverse effects*
Methotrexate / adverse effects*
Pneumonia / chemically induced*,  diagnosis*
Pulmonary Alveoli / pathology*
Radiography, Thoracic
Reg. No./Substance:
0/Immunosuppressive Agents; 59-05-2/Methotrexate

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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