REVIEW - MTX pneumonitis: review of the literature and histopathological findings in nine patients

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Eur Respir J 2000; 15: 373-381

Copyright © ERS Journals Ltd 2000

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Original Articles

Methotrexate pneumonitis: review of the literature and histopathological

findings in nine patients

S Imokawa, TV Colby, KO , and RA Helmers

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.

http://erj.ersjournals.com/cgi/content/abstract/15/2/373

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