[Acute respiratory distress syndrome due to pneumonitis following intrathecal methotrexate administration].
BACKGROUND
Methotrexate, given orally or systemically, is associated with pneumonitis in 7% of cases.


METHODS
This case report describes acute respiratory distress syndrome, due to diffuse pneumonitis, in a patient with malignant non-Hodgkin's lymphoma being treated with combination chemotherapy which included doxorubicin, cyclophosphamide, bleomycin, vindesin and intrathecal methotrexate with G-CSF (filgrastine- Neupogen). The clinical course, the lack of an identifiable infectious agent and the complete response to corticosteroids suggested a drug-induced cause. After ruling out the other chemotherapy agents, methotrexate was considered to be the causal agent. The unusual feature of this case was that pneumonitis developed after intrathecal administration of methotrexate.


CONCLUSIONS
Methotrexate-associated respiratory complications can occur with whichever route the drug is administered.
Le Guillou
F
F
Clinique pneumologique, CHU, Rouen, France.
Dominique
S
S
Dubruille
V
V
Contentin
N
N
Tilly
H
H
Nouvet
G
G
D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D000964:Antimetabolites, Antineoplastic / Q000008:administration & dosage / Q000009:adverse effects*; D018906:Antineoplastic Agents, Alkylating / Q000008:administration & dosage; D000972:Antineoplastic Agents, Phytogenic / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001761:Bleomycin / Q000008:administration & dosage; D001992:Bronchoalveolar Lavage Fluid / Q000166:cytology; D001999:Bronchoscopy; D003520:Cyclophosphamide / Q000008:administration & dosage; D004317:Doxorubicin / Q000008:administration & dosage; D000069585:Filgrastim; D016179:Granulocyte Colony-Stimulating Factor / Q000008:administration & dosage; D006801:Humans; D007278:Injections, Spinal; D007958:Leukocyte Count; D008228:Lymphoma, Non-Hodgkin / Q000188:drug therapy; D008297:Male; D008727:Methotrexate / Q000008:administration & dosage / Q000009:adverse effects*; D008875:Middle Aged; D011014:Pneumonia / Q000139:chemically induced* / Q000175:diagnosis / Q000188:drug therapy; D011994:Recombinant Proteins; D012128:Respiratory Distress Syndrome / Q000139:chemically induced* / Q000175:diagnosis / Q000188:drug therapy; D013256:Steroids; D014057:Tomography, X-Ray Computed; D014751:Vindesine / Q000008:administration & dosage
D000893:Anti-Inflammatory Agents; D000964:Antimetabolites, Antineoplastic; D018906:Antineoplastic Agents, Alkylating; D000972:Antineoplastic Agents, Phytogenic; D011994:Recombinant Proteins; D013256:Steroids; D001761:Bleomycin; D016179:Granulocyte Colony-Stimulating Factor; D004317:Doxorubicin; D003520:Cyclophosphamide; D000069585:Filgrastim; D014751:Vindesine; D008727:Methotrexate