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Methotrexate-induced pleuropericarditis and eosinophilic pleural effusion
Corey Cudzilo1, Alejandro Aragaki, Julian Guitron
1Departments of *Internal Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine †Surgery, Division of Thoracic Surgery, University of Cincinnati ‡Veterans Affairs Medical Center, Cincinnati, OH.
Journal of Bronchology & Interventional Pulmonology
|January 15, 2014
Summary
Methotrexate can cause serious side effects, including eosinophilic pleural effusion, a rare lung condition. This case highlights the importance of monitoring patients for adverse reactions during treatment.
Area of Science:
- Rheumatology
- Pulmonology
- Dermatology
Background:
- Methotrexate is a common immunosuppressant used for autoimmune diseases like psoriatic arthritis.
- Adverse drug reactions can manifest in various organ systems, including the pleura.
Observation:
- A 41-year-old man with psoriatic arthritis developed a widespread skin rash after initiating methotrexate therapy.
- He subsequently experienced recurrent eosinophilic pleural effusions and hemorrhagic pericardial effusion.
- Pleural biopsies revealed chronic inflammation with eosinophils, excluding malignancy.
Findings:
- The patient's symptoms, including dyspnea and pleural effusions, were temporally associated with methotrexate re-initiation.
- Discontinuation of methotrexate and subsequent corticosteroid treatment led to symptom improvement.
Implications:
- This case underscores the potential for methotrexate to induce severe pulmonary complications, specifically eosinophilic pleural effusions.
- Close monitoring for respiratory symptoms and prompt evaluation are crucial in patients receiving methotrexate.
- Further research into the mechanisms of methotrexate-induced lung injury is warranted.
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