Browse > Article

A Case of Hypersensitivity Pneumonitis Caused by Methotrexate  

Suh, Hyun Joo (Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine)
Chung, Man Pyo (Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine)
Park, Eun Ha (Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine)
Shin, Sung Chul (Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine)
Jeon, Kyeong Man (Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine)
Yu, Chang Min (Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine)
Pyun, Yu Jang (Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine)
Lee, Kyung Soo (Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine)
Han, Joungho (Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine)
Publication Information
Tuberculosis and Respiratory Diseases / v.56, no.2, 2004 , pp. 203-209 More about this Journal
Abstract
Background : Methotrexate (MTX) has been used to treat a wide range of malignant and benign diseases including osteosarcoma, advanced stage non-Hodgkin's lymphoma, psoriasis, severe rheumatoid arthritis, sarcoidosis, and Wegener's granulomatosis. MTX-induced lung injury occurs in up to 10% of treated patients. Although both acute and chronic presentations have been described, typical manifestation of MTX-induced lung injury is subacute with symptoms usually developing within several months after starting therapy. Nonspecific interstitial pneumonia (NSIP) is the most common histopathologic manifestation of MTX-induced lung disease, while bronchiolitis obliterans organizing pneumonia (BOOP) and diffuse alveolar damage (DAD) are less common. Granuloma formation is reported in 34.7%. In Korea, Two reports of MTX pneumonitis have been published. The one presented with NSIP and the other with DAD. We recently experienced a case of MTX pneumonitis with presentation of hypersensitivity pneumonitis.
Keywords
Methotrexate; Hypersensitivity pneumonitis;
Citations & Related Records

Times Cited By SCOPUS : 2
연도 인용수 순위
1 류재춘, 김대현, 오세익, 박상현, 이윤우, 김동순 등. 류마토이드 관절염 환자에서 저용량의 methotrexate투여후 유발된 폐독성 1예. 대한내과학회 1994;46:867-1
2 염호기, 한성훈, 김형곤, 이윤우, 이혜경, 전우기 등. 림프구 자극시험으로 확진된 금제에 의한 과민성 폐렴 1례. 결핵 및 호흡기 질환 1994;41:546
3 Kramer N, Chuzhin Y, Kaufman LD, Ritter JM, Rosenstein ED. Methotrexate pneumonitis after initiation of infliximab therapy for rheumatoid arthritis. Arthritis Rheum. 2002; 47:670-1
4 Imokawa S, Colby TV, Lesilie KO, Helmers RA. Methotrexate pneumonitis: review of the literature and histopathological findings in nine patients. Eur Respir J 2000;15:373-81
5 김지연, 김완욱, 김성일, 류완희, 박성환, 홍연식 등. 류마티스 관절염 환자에서 methotrexate와 관련된 간질성 폐렴 1예. 대한류마치스학회 1998;5:126-32
6 White DA, Rankin JA, Stover DE, Gellene RA, Guta S: Methotrexate pneumonitis: bronchoalveolar lavage findings suggest an immunologic disorder. Am Rev Respir Dis 1989;139:18-21
7 Carroll GJ, Thomas R, Phatouros CC, Atchison MH, Leslie A, Cook NJ et al. Incidence, prevalence and possible risk factors for pneumonitis in patients with rheumatoid arthritis receiving methotrexate. J Rheumatol 1994;21:51-4
8 F. Salaffi, P. Managanelli, M. Carotti, S. Subiaco, G. Lamanna, C. Cervini. Methotrexate induced pneumonitis in patients with rheumatoid arthritis and psoriatic arthritis. Clin Rheumatol. 1997;16:296-304
9 Leland L. Fan. Hypersensitivity pneumonitis in children. Curr Opinion Pediatrics 2002;14:323-6
10 Fuhrman C, Parrot A, Wislez M, Prigent H, Roussaud V, Bernaudin F et al. Spectrum of CD4 to CD8 T-cell ratios in lymphocytic alveolitis associated with methotrexat-in-duced pneumonitis. Am J Crit Care Med 2001;164:1186-91
11 B. F. Leeb, C. Scheinecker, H. Schweitzer, J. S. Smolen. Tow Different Drug-Induced Pulmonary Complications in a Patient Suffering from Rheumatoid arthritis. Br J Rheumatol. 1998;37:586-7
12 Schnabel A, Richter C, Bauerfeind S, Gross WL. Bronchoalveolar lavage cell profile in methotrexate induced pneumonitis. Thorax 1997;52:377-9
13 Jeremy J. Erasmus, H. Page McAdams, Santiago E. Rossi. High resolution CT of drug induced lung disease. Radiologic Clinics of North America 2002;40:61-72