title: [A case of pneumocystis carinii pneumonia associated with low dose methotrexate treatment for rheumatoid arthritis and trimethoprim-sulphamethoxazole induced pancytopenia].
abstract: A 64-year-old man was admitted to our hospital complaining of dyspnea and fever. He had been treated with low-dose methotrexate for rheumatoid arthritis. Chest radiography showed diffuse ground-glass attenuation in both lung fields, and hypoxia was detected. Pneumosystis carinii pneumonia was demonstrated on transbronchial lung biopsy, and the serum beta-D glucan level was high. We started treatment with trimethoprim-sulphamethoxazole, but respiratory failure worsened, and drug-induced pancytopenia occurred. Although trimethoprim-sulphamethoxazole was stopped, pancytopenia persisted and the patient required ventilatory support. After we changed the medication from trimethoprim-sulphamethoxazole to pentamidine, respiratory failure improved. It was thought that pneumocystis carinii pneumonia was associated with low-dose methotrexate and that trimethoprim-sulphamethoxazole interacted with methotrexate to induce severe pancytopenia.
authors.affiliation: Division of Cardiovascular and Respiratory Medicine Department of Internal Medicine Kobe University Graduate School of Medicine.
authors.forename: Temiko
authors.initials: T
authors.lastname: Shimada
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Nishimura
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Funada
authors.forename: Kaori
authors.initials: K
authors.lastname: Takenaka
authors.forename: Kazuyuki
authors.initials: K
authors.lastname: Kobayashi
authors.forename: Yoshiko
authors.initials: Y
authors.lastname: Urata
authors.forename: Sho
authors.initials: S
authors.lastname: Yosimura
authors.forename: Teruaki
authors.initials: T
authors.lastname: Nishiuma
authors.forename: Miyako
authors.initials: M
authors.lastname: Satouchi
authors.forename: Mitsuhiro
authors.initials: M
authors.lastname: Yokoyama
mesh_terms: D000890:Anti-Infective Agents / Q000009:adverse effects*; D018501:Antirheumatic Agents / Q000008:administration & dosage / Q000009:adverse effects; D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008727:Methotrexate / Q000008:administration & dosage / Q000009:adverse effects*; D008875:Middle Aged; D010198:Pancytopenia / Q000139:chemically induced*; D011020:Pneumonia, Pneumocystis / Q000188:drug therapy* / Q000209:etiology*; D020551:Pulse Therapy, Drug; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000009:adverse effects*
chemical_list: D000890:Anti-Infective Agents; D018501:Antirheumatic Agents; D015662:Trimethoprim, Sulfamethoxazole Drug Combination; D008727:Methotrexate