Successful treatment of bronchiolitis obliterans organizing pneumonia withlow-dose methotrexate in a patient with Hodgkin's disease

Bronchiolitis obliterans organizing pneumonia (BOOP) is a rare disease, whi ch is histopathologically defined by the presence of granulation tissue in the bronchioles, alveolar ducts and alveoli leading to plugging of the bron chiolar and alveolar lumen. BOOP is considered as a nonspecific response to many types of lung injury, including drugs, radiation, an underlying hemat ologic malignant neoplasm, autoimmune diseases, bacterial or virus infectio n, or an underlying lung disease, or occurs idiopathically. BOOP is mainly treated with corticosteroids, which induce a rapid clinical improvement. A frequent problem is relapse of disease when corticosteroid dosage is tapere d off. We present the case of a 20-year-old patient with Hodgkin's disease developing BOOP after chemotherapy (COPP/ABVD) and irradiation. Initially, she responded well to corticosteroids, but relapsed when medication was dis continued. Complete remission of BOOP was achieved by long-term treatment w ith low-dose methotrexate (5-20 mg/week, i.v.). Copyright (C) 2001 S. Karge r AG, Basel.