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Nocardia asteroides pneumonia complicating low dose methotrexate treatment of refractory rheumatoid arthritis
J J Cornelissen1, L J Bakker, M J Van der Veen
1Department of Rheumatology, University Hospital Utrecht.
Abstract:
Low dose methotrexate is used increasingly often in the treatment of rheumatoid arthritis. Severe complications due to toxicity of the lung or bone marrow occur infrequently. This report describes a 71 year old woman with longstanding rheumatoid arthritis who developed pleuritis, a pulmonary infiltrate, and pancytopenia during treatment with low dose methotrexate. Fatal respiratory insufficiency followed, and cultures from the lung after death showed Nocardia asteroides.
Insights
Low dose methotrexate for rheumatoid arthritis can cause rare lung and bone marrow toxicity. A patient developed fatal Nocardia pneumonia and pancytopenia, highlighting potential severe methotrexate complications.
Area of Science:
- Rheumatology
- Pulmonology
- Infectious Diseases
Background:
- Low-dose methotrexate is a common treatment for rheumatoid arthritis.
- Severe methotrexate toxicity, particularly affecting the lungs or bone marrow, is infrequent.
Observation:
- A 71-year-old woman with rheumatoid arthritis developed pleuritis, pulmonary infiltrate, and pancytopenia.
- These symptoms emerged during treatment with low-dose methotrexate.
Findings:
- The patient experienced fatal respiratory insufficiency.
- Post-mortem lung cultures revealed Nocardia asteroides infection.
Implications:
- This case highlights a rare but severe complication of low-dose methotrexate therapy.
- Methotrexate may increase susceptibility to opportunistic infections like Nocardia in rheumatoid arthritis patients.
- Clinicians should consider opportunistic infections in patients with rheumatoid arthritis on methotrexate presenting with pulmonary and hematologic abnormalities.