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[Methotrexate-induced interstitial pneumonitis in a child with acute lymphoblastic leukemia]

Chiho Tatsumoto1, Kiyoshi Kawakami, Jun Nagayama

  • 1Department of Pediatrics, Kagoshima City Hospital.

[Rinsho Ketsueki] the Japanese Journal of Clinical Hematology
|November 24, 2004
PubMed

Insights

Methotrexate (MTX) can cause interstitial pneumonitis in children with acute lymphoblastic leukemia. This rare complication requires physician awareness during maintenance therapy.

Area of Science:

  • Pediatric Oncology
  • Pulmonology
  • Pharmacology

Background:

  • Acute lymphoblastic leukemia (ALL) is a common childhood cancer.
  • Methotrexate (MTX) is a key chemotherapeutic agent used in ALL treatment.
  • Long-term, low-dose MTX is often employed for maintenance therapy.

Observation:

  • A 5-year-old boy with ALL developed fever, cough, dyspnea, and hypoxemia during MTX maintenance therapy.
  • Clinical, radiological, and laboratory findings supported a diagnosis of MTX-induced interstitial pneumonitis.
  • The patient's condition improved after discontinuing MTX.

Findings:

  • MTX-induced interstitial pneumonitis is a recognized adverse effect, though rarely reported in pediatric leukemia.
  • This case highlights a potential severe pulmonary complication of low-dose MTX in children with ALL.
  • The prevalence in adult rheumatoid arthritis patients is 0.3-7.5%, but data in pediatric leukemia is scarce.

Implications:

  • Physicians must consider MTX pneumonitis in children with ALL presenting with respiratory symptoms during maintenance therapy.
  • Early recognition and MTX cessation are crucial for patient recovery.
  • Further research is needed to understand the incidence and risk factors of MTX pneumonitis in pediatric leukemia.

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