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. 2010 Oct 31;5(5):312-9.
doi: 10.1186/2049-6958-5-5-312.

Methotrexate-induced pneumonitis in Crohn's disease. Case report and review of the literature

Nadia D'Andrea  1 , Luca Triolo, Giovanna Margagnoni, Annalisa Aratari, Claudio M Sanguinetti
Affiliations

Methotrexate-induced pneumonitis in Crohn's disease. Case report and review of the literature

Nadia D'Andrea et al. Multidiscip Respir Med. .

Abstract

Methotrexate (MTX) is a folate-antagonist used in several neoplastic and inflammatory diseases. Reports of pulmonary complications in patients given low-dose MTX therapy are increasing. Pulmonary toxicity from MTX has a variable frequency and can present with different forms. Most often MTX-induced pneumonia in patients affected by rheumatoid arthritis (RA) is reported.In this paper we describe a case of MTX-related pneumonitis in a relatively young woman affected by Crohn's disease who presented non-productive cough, fever and dyspnea on exercise. Chest X-ray demonstrated bilateral interstitial infiltrates and at computed tomography (CT) ground-glass opacities appeared in both lungs. At spirometry an obstructive defect was demonstrated. A rapid improvement of symptoms and the regression of radiographic and spirometric alterations was achieved through MTX withdrawal and the introduction of corticosteroid therapy.

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Figures

Figure 1a
Figure 1a
HRCT of lung during methotrexate therapy. Diffuse bilateral alveolar infiltrates and ground glass areas can be seen without distortion of pulmonary parenchyma. Definition of abbreviation: HRCT, high-resolution computed tomography.
Figure 1b
Figure 1b
PFT at admission to hospital. Mild obstructive defect with severe reduction of DLCO. Definition of abbreviations: DLCO, diffusing lung capacity for carbon monoxide; FEV1, forced expiratory volume in 1 second; FVC, forced vital capacity; PFT, pulmonary function test; TLC, total lung capacity; VC, vital capacity.
Figure 2a
Figure 2a
HRCT of lung after discontinuation of methotrexate therapy. No lung abnormalities can be observed. Definition of abbreviation: HRCT, high-resolution computed tomography.
Figure 2b
Figure 2b
PFT at outcome. Normalization of functional parameters. Definition of abbreviations: DLCO, diffusing lung capacity for carbon monoxide; FEV1, forced expiratory volume in 1 second; FVC, forced vital capacity; PFT, pulmonary function test; TLC, total lung capacity; VC, vital capacity.
See this image and copyright information in PMC

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