Rheumatoid arthritis associated with methotrexate-induced pneumonitis: improvement with i.v. cyclophosphamide therapy.
Pneumonitis is one of the most serious adverse effects associated with low-dose weekly methotrexate (MTX) therapy. Immediate cessation of MTX, and the introduction of oxygen therapy and glucocorticoids usually results in a dramatic improvement in the pulmonary toxicity. We report here a case of MTX-induced pneumonitis in a patient with rheumatoid arthritis (RA). Severe hypoxemia and interstitial infiltration in both lung fields did not respond to the withdrawal of MTX and the administration of oxygen and steroid pulse therapy. When intravenous cyclophosphamide (CYC) pulse therapy was initiated, however, rapid physiologic and radiographic improvement was seen. Our case suggests that CYC treatment may have a beneficial effect on MTX-induced pneumonitis that is resistant to steroid therapy.
Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan.
A
A
Suwa
M
M
Hirakata
S
S
Satoh
T
T
Mimori
K
K
Utsumi
S
S
Inada
D000368:Aged; D018501:Antirheumatic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D003520:Cyclophosphamide / Q000008:administration & dosage / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000627:therapeutic use; D007262:Infusions, Intravenous; D017563:Lung Diseases, Interstitial / Q000139:chemically induced / Q000175:diagnosis / Q000188:drug therapy; D008727:Methotrexate / Q000009:adverse effects* / Q000627:therapeutic use; D011014:Pneumonia / Q000139:chemically induced* / Q000175:diagnosis / Q000188:drug therapy
D018501:Antirheumatic Agents; D007166:Immunosuppressive Agents; D003520:Cyclophosphamide; D008727:Methotrexate