Open AccessMethotrexate pneumonitis: review of the literature and histopathological findings in nine patients
Author(s) -
Imokawa S,
Colby T.V,
Leslie K.O,
Helmers R.A
Publication year - 2000
Publication title -
european respiratory journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 4.021
H-Index - 241
eISSN - 1399-3003
pISSN - 0903-1936
DOI - 10.1034/j.1399-3003.2000.15b25.x
Subject(s) - medicine , methotrexate , pneumonitis , crackles , lung biopsy , diffuse alveolar damage , hypersensitivity pneumonitis , lung , respiratory distress , pathological , biopsy , adverse effect , pulmonary function testing , chest radiograph , pathology , surgery , acute respiratory distress
Pneumonitis is a serious and unpredictable side‐effect of treatment with methotrexate (MTX) that may become life‐threatening. The clinical and histological features of nine cases of MTX pneumonitis are reported and the literature reviewed. The typical clinical symptoms include progressive shortness of breath and cough, often associated with fever. Hypoxaemia and tachypnoea are always present and crackles are frequently audible. Chest radiography reveals a diffuse interstitial or mixed interstitial and alveolar infiltrate, with a predilection for the lower lung fields. Pulmonary function tests show a restrictive pattern with diminished diffusion capacity. Lung biopsy reveals cellular interstitial infiltrates, granulomas or a diffuse alveolar damage pattern accompanied by perivascular inflammation. These clinical and pathological findings are not specific to MTX pneumonitis and can be seen with other drug‐induced lung toxicities. It is important that all patients receiving methotrexate be educated concerning this potential adverse reaction and instructed to contact their physicians should significant new pulmonary symptoms develop while undergoing therapy. If methotrexate pneumonitis is suspected, methotrexate should be discontinued, supportive measures instituted and careful examination for different causes of respiratory distress conducted.