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Pneumonitis complicating methotrexate therapy for pustular psoriasis
M Ameen1, D A Taylor, I P Williams
1St Johnś Institute of Dermatology, St Thomas' Hospital, London, UK. mahreenameen@hotmail.com
Summary
A patient with pustular psoriasis developed interstitial pneumonitis from long-term methotrexate (MTX) treatment. Early respiratory symptom investigation is crucial, as this potentially fatal complication is reversible with drug withdrawal and corticosteroids.
Area of Science:
- Pulmonology
- Dermatology
- Pharmacology
Background:
- Methotrexate (MTX) is a common treatment for psoriasis.
- Pulmonary toxicity is a rare but serious adverse effect of MTX.
- Interstitial pneumonitis is an uncommon complication, especially in psoriatic patients.
Observation:
- A patient with pustular psoriasis experienced interstitial pneumonitis.
- The patient had been on weekly MTX therapy for 26 years at an average dose of 20 mg.
- Respiratory symptoms developed during the treatment course.
Findings:
- Withdrawal of MTX and administration of corticosteroids led to a dramatic patient response.
- This suggests MTX-induced interstitial pneumonitis was the cause of the pulmonary issue.
- Early identification and intervention are key for managing this complication.
Implications:
- Clinicians should be vigilant for respiratory symptoms in patients on long-term MTX, even at low doses.
- Prompt investigation of early respiratory symptoms is vital for potentially fatal but reversible MTX-induced pneumonitis.
- This case highlights the importance of considering MTX pulmonary toxicity in psoriatic patients presenting with respiratory complaints.