title: Successful treatment of steroid-resistant methotrexate-induced interstitial pneumonia with peripherally administered ulinastatin.
abstract: A 76-year-old woman with rheumatoid arthritis who had been taking methotrexate (MTX) for 9 months was admitted because of acute respiratory failure. A chest radiograph revealed diffuse ground-glass attenuation. MTX-induced interstitial pneumonia (IP) was strongly suspected. Her respiratory failure worsened in spite of steroid pulse therapy. Intravenous administration of ulinastatin, however, dramatically improved her clinical condition. The second ulinastatin treatment was also effective. This case suggests that peripherally administered ulinastatin may be effective for steroid-resistant MTX-induced IP.
authors.affiliation: Department of Rheumatology, Ome Municipal General Hospital, 4-16-5 Higashi-Ome, Ome, Tokyo, 198-0042, Japan.
authors.forename: Hayato
authors.initials: H
authors.lastname: Yamazaki
authors.forename: Kenji
authors.initials: K
authors.lastname: Nagasaka
mesh_terms: D000368:Aged; D004351:Drug Resistance / Q000187:drug effects; D004359:Drug Therapy, Combination; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D006023:Glycoproteins / Q000627:therapeutic use*; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D017563:Lung Diseases, Interstitial / Q000139:chemically induced / Q000188:drug therapy / Q000503:physiopathology; D008727:Methotrexate / Q000009:adverse effects*; D011239:Prednisolone / Q000627:therapeutic use; D012131:Respiratory Insufficiency / Q000139:chemically induced / Q000188:drug therapy / Q000503:physiopathology; D014361:Trypsin Inhibitors / Q000627:therapeutic use*
chemical_list: D005938:Glucocorticoids; D006023:Glycoproteins; D007166:Immunosuppressive Agents; D014361:Trypsin Inhibitors; D011239:Prednisolone; C028665:urinastatin; D008727:Methotrexate