title: Accelerated pulmonary nodulosis and sterile pleural effusion in a patient with psoriatic arthropathy during methotrexate therapy: a case report.
abstract: Pulmonary nodulosis and sterile pleural exudates are well-known extra-articular manifestations in rheumatoid arthritis patients with a positive rheumatoid factor. In some patients, treatment with methotrexate has been postulated as the trigger of these complications. We report a patient with psoriatic arthropathy, negative RF, negative anticyclic citrulinated peptide antibodies but positive antibodies to cardiolipin who developed massive sterile pleural empyema and multiple cavitary pulmonary nodules during methotrexate treatment. We suggest that awareness of methotrexate-induced lung and pleural complications should be extended to other than rheumatoid arthritis diseases, not necessarily accompanied by rheumatoid factor or anticyclic citrulinated peptide antibodies.
authors.affiliation: B. Shine Department of Rheumatology, Rambam Health Care Campus, Haifa, Israel. a_balbir@rambam.health.gov.il
authors.forename: Alexandra
authors.initials: A
authors.lastname: Balbir-Gurman
authors.forename: Ludmila
authors.initials: L
authors.lastname: Guralnik
authors.forename: Lael-Anson
authors.initials: LA
authors.lastname: Best
authors.forename: Eugene
authors.initials: E
authors.lastname: Vlodavsky
authors.forename: Mordehai
authors.initials: M
authors.lastname: Yigla
authors.forename: Abraham
authors.initials: A
authors.lastname: Menahem Nahir
authors.forename: Yolanda
authors.initials: Y
authors.lastname: Braun-Moscovici
mesh_terms: D018501:Antirheumatic Agents / Q000009:adverse effects*; D015535:Arthritis, Psoriatic / Q000188:drug therapy*; D016724:Empyema, Pleural / Q000139:chemically induced* / Q000150:complications; D005260:Female; D006801:Humans; D008727:Methotrexate / Q000009:adverse effects*; D008875:Middle Aged; D055613:Multiple Pulmonary Nodules / Q000139:chemically induced* / Q000150:complications
chemical_list: D018501:Antirheumatic Agents; D008727:Methotrexate