[A case of pneumocystis carinii pneumonia associated with low dose methotrexate treatment for rheumatoid arthritis and trimethoprim-sulphamethoxazole induced pancytopenia].
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.
Shimada
Temiko
T
Division of Cardiovascular and Respiratory Medicine Department of Internal Medicine Kobe University Graduate School of Medicine.
Nishimura
Yoshihiro
Y
Funada
Yasuhiro
Y
Takenaka
Kaori
K
Kobayashi
Kazuyuki
K
Urata
Yoshiko
Y
Yosimura
Sho
S
Nishiuma
Teruaki
T
Satouchi
Miyako
M
Yokoyama
Mitsuhiro
M
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*
D000890:Anti-Infective Agents; D018501:Antirheumatic Agents; D015662:Trimethoprim, Sulfamethoxazole Drug Combination; D008727:Methotrexate