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Pneumocystis carinii pneumonia associated with methotrexate therapy in rheumatoid arthritis
D A Flood1, C K Chan, W Pruzanski
1Department of Medicine, Wellesley and Princess Margaret Hospitals, University of Toronto, ON, Canada.
Abstract:
Opportunistic infections occur in patients with rheumatic diseases treated with low dose methotrexate (MTX) with or without other immunosuppressants. Our case report illustrates a fatal case of Pneumocystis carinii pneumonia in a patient with rheumatoid arthritis treated with low dose MTX and glucocorticoid. A review of the literature reveals other opportunistic infections such as Cryptococcus, Nocardia, and herpes zoster presenting in such patients. These occurrences suggest that MTX should be used cautiously in patients with rheumatic disease receiving concomitant medical therapy.
Insights
Low dose methotrexate (MTX) can cause opportunistic infections in rheumatic disease patients. Careful monitoring is crucial, especially when combined with other immunosuppressants, to prevent serious complications like fatal pneumonia.
Area of Science:
- Rheumatology
- Infectious Diseases
- Pharmacology
Background:
- Rheumatic diseases often require immunosuppressive therapy, including low-dose methotrexate (MTX).
- Patients on MTX may be at increased risk for opportunistic infections.
- Concomitant use of other immunosuppressants can further elevate this risk.
Observation:
- A case report details a fatal instance of Pneumocystis carinii pneumonia.
- The patient had rheumatoid arthritis and was treated with low-dose MTX and glucocorticoids.
- Literature review identified other opportunistic infections (Cryptococcus, Nocardia, herpes zoster) in similar patients.
Findings:
- Low-dose methotrexate, particularly when combined with glucocorticoids or other immunosuppressants, is associated with opportunistic infections.
- Pneumocystis carinii pneumonia represents a severe, potentially fatal, risk in this patient population.
- A spectrum of opportunistic pathogens can affect patients on MTX for rheumatic conditions.
Implications:
- Methotrexate should be prescribed with caution in patients with rheumatic diseases.
- Clinicians must be vigilant for signs of opportunistic infections in patients on MTX.
- Risk-benefit assessment is essential when considering MTX, especially with concurrent immunosuppressive therapies.