Cw. Israel et al., SEVERE PNEUMONITIS AS COMPLICATION OF LOW -DOSAGE METHOTREXATE TREATMENT OF PSORIASIS-ASSOCIATED RHEUMATOID-ARTHRITIS, Deutsche Medizinische Wochenschrift, 120(17), 1995, pp. 603-608
A 71-year-old woman with psoriasis-associated rheumatoid arthritis had
for 15 months been treated with methotrexate (5 mg/week orally). Four
weeks before admission she had developed dyspnoea and cough. On admis
sion her axillary temperature was 38,2 degrees C, the white cell count
was normal. Erythrocyte sedimentation rate (50/90 mm), lactate dehydr
ogenase activity (449 U/l) and the creatinine level (1,33 mg/dl) were
all elevated. Blood gas analysis revealed partial respiratory impairme
nt (pO(2) 52 mmHg), and the chest X-ray demonstrated bilateral interst
itial-alveolar changes. Despite antibiotics the temperature continued
to rise, and on the 11th day a blood eosinophilia of 4% was noted. The
bronchial mucosa was normal on bronchoscopy, and transbronchial biops
y showed only minor interstitial fibrosis, occasional macrophages and
lymphocytes. Cultures of the lavage-fluid were negative: As methotrexa
te pneumonitis was suspected the drug was discontinued and prednisolon
e administered (50 mg daily for 3 days, gradually reducing over 7 days
). The symptoms quickly improved, and blood gas analysis and the X-ray
s became normal. The patient was discharged symptom-free after 30 days
.