FATAL PULMONARY FIBROSIS COMPLICATING LOW-DOSE METHOTREXATE THERAPY FOR RHEUMATOID-ARTHRITIS

We report the fatal disease course of 2 aged patients with rheumatoid arthritis (RA). Both had respiratory complaints after 10-15 weeks of t reatment with methotrexate (MTX). After withdrawal of MTX, and despite the use of corticosteroids and ventilatory support, both died of resp iratory failure. Post mortem examination showed extensive pulmonary fi brosis, bronchiolitis obliterans, and hyperplasia of type II pneumocyt es. To our knowledge, this is the first report of fatal pulmonary fibr osis following short courses of low dose MTX therapy for RA.