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Fatal methotrexate-induced pneumonitis in a psoriatic patient

Elias Mazokopakis1, Konstantinos Katsogridakis, Anastasios Koutsopoulos

  • 1Division of General Internal Medicine, University General Hospital of Heraklion Crete, 71 110 Heraklion, Crete, Greece.

Military Medicine
|May 11, 2004
PubMed

Insights

Methotrexate (MTX) therapy can cause rare but fatal lung toxicity in psoriatic arthritis patients. Early investigation of new respiratory symptoms is crucial, even with low-dose MTX, due to the risk of severe pneumonitis.

Area of Science:

  • Rheumatology
  • Pulmonology
  • Clinical Pharmacology

Background:

  • Methotrexate (MTX) is a common disease-modifying antirheumatic drug (DMARD) used for psoriatic arthritis.
  • Pulmonary toxicity is an uncommon but serious adverse effect of MTX therapy.
  • Psoriatic patients are generally considered at low risk for MTX-induced lung disease.

Observation:

  • This case report details a patient with psoriatic arthritis who developed fatal pneumonitis.
  • The patient received a low dose of MTX (15 mg weekly) for only one month.
  • Histopathological examination revealed diffuse alveolar damage in the organizing stage.

Findings:

  • Despite prompt MTX withdrawal, corticosteroid treatment, and supportive care, the patient succumbed to the pneumonitis.
  • This highlights the potentially rapid and severe progression of MTX-induced lung injury.
  • The patient's presentation underscores that even low-dose MTX can precipitate severe pulmonary complications.

Implications:

  • Clinicians should maintain a high index of suspicion for MTX pneumonitis in psoriatic arthritis patients presenting with new pulmonary symptoms.
  • Pulmonary evaluation is warranted regardless of MTX dosage or duration of therapy.
  • This case emphasizes the need for prompt diagnosis and management of MTX-related lung injury to potentially improve patient outcomes.

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