title: Three cases of malignant neoplasm, pneumonitis, and pancytopenia during treatment with low-dose methotrexate.
abstract: A 77-year-old man with chronic obstructive pulmonary disease was treated with low-dose methotrexate (7.5-15 mg per week). After 15 months a diagnosis of urothelial carcinoma of the bladder was made; after a further 6 months pneumonitis and pancytopenia developed. The patient died due to massive pulmonary hemorrhage. A malignant teratoma was diagnosed in a 65-year-old asthmatic man 16 months after initiation of methotrexate therapy (15 mg per week). The patient died 4 months later due to fulminant progression of the neoplasm. A third malignant neoplasm (dermal squamous cell carcinoma) was seen in a 64-year-old woman with rheumatoid arthritis after 13 months treatment with 7.5 mg methotrexate per week. These three cases, while obviously not proving a causal relationship between long-term treatment with low-dose methotrexate and development of malignant neoplasm, do call for stringent treatment criteria, close surveillance, and prospective studies.
authors.affiliation: Medizinische Klinik, Krankenhaus des Landkreises Starnberg.
authors.forename: P
authors.initials: P
authors.lastname: Trenkwalder
authors.forename: H
authors.initials: H
authors.lastname: Eisenlohr
authors.forename: K
authors.initials: K
authors.lastname: Prechtel
authors.forename: H
authors.initials: H
authors.lastname: Lydtin
mesh_terms: D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000139:chemically induced; D005260:Female; D006801:Humans; D008173:Lung Diseases, Obstructive / Q000150:complications / Q000188:drug therapy*; D008297:Male; D008727:Methotrexate / Q000008:administration & dosage / Q000009:adverse effects*; D008875:Middle Aged; D009369:Neoplasms / Q000139:chemically induced*; D010198:Pancytopenia / Q000139:chemically induced*; D011014:Pneumonia / Q000139:chemically induced*; D012878:Skin Neoplasms / Q000139:chemically induced; D013724:Teratoma / Q000139:chemically induced; D001749:Urinary Bladder Neoplasms / Q000139:chemically induced
chemical_list: D008727:Methotrexate