title: Late-onset methotrexate-induced pneumonitis with neutrophilia in bronchoalveolar lavage fluid.
abstract: A 61-year-old woman being treated with methotrexate (MTX) 8-10 mg/week and prednisolone 2.5 mg/day for rheumatoid arthritis presented with a 1-week history of increasing fever and dry cough. The patient deteriorated with administration of antibiotics. Chest CT scan showed bilateral diffuse ground-glass opacities. Analysis of bronchoalveolar lavage fluid (BALF) revealed marked neutrophilia (65.2% of total cells). The specimen from transbronchial lung biopsy showed a non-specific interstitial pneumonia pattern. Following withdrawal of the MTX, her pulmonary infiltration, clinical symptoms and laboratory findings gradually improved. Therefore, she was diagnosed as having MTX-induced pneumonitis. Lymphocytosis in BALF has been identified as a characteristic of MTX-induced pneumonitis, particularly in late onset of this disease. However, the BALF in our patient was neutrophilic. Although neutrophilia in BALF of patients with drug-induced pneumonitis is usually associated with poor outcome, rare cases of good outcome do exist.
authors.affiliation: Respiratory Medicine, Jikei University School of Medicine, Kashiwa Hospital, Kashiwa, Japan.
authors.forename: Hideaki
authors.initials: H
authors.lastname: Yamakawa
authors.affiliation: Respiratory Medicine, Jikei University School of Medicine, Kashiwa Hospital, Kashiwa, Japan.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Yoshida
authors.affiliation: Respiratory Medicine, Jikei University School of Medicine, Kashiwa Hospital, Kashiwa, Japan.
authors.forename: Masamichi
authors.initials: M
authors.lastname: Takagi
authors.affiliation: Respiratory Medicine, Jikei University School of Medicine, Tokyo, Tokyo, Japan.
authors.forename: Kazuyoshi
authors.initials: K
authors.lastname: Kuwano
mesh_terms: D018501:Antirheumatic Agents / Q000009:adverse effects*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D001992:Bronchoalveolar Lavage Fluid / Q000166:cytology; D005260:Female; D006801:Humans; D008727:Methotrexate / Q000009:adverse effects*; D008875:Middle Aged; D009504:Neutrophils / Q000166:cytology; D011014:Pneumonia / Q000139:chemically induced* / Q000276:immunology
chemical_list: D018501:Antirheumatic Agents; D008727:Methotrexate