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Pneumocystis carinii pneumonia complicating low dose methotrexate treatment for psoriatic arthropathy

P J Wallis1, K S Ryatt, T J Constable

  • 1Department of Medicine, Manor Hospital, Walsall, West Midlands.

Annals of the Rheumatic Diseases
|March 1, 1989
PubMed

Insights

A patient developed severe Pneumocystis pneumonia while on low-dose methotrexate for psoriasis. This serious complication may have been caused by combining methotrexate with NSAIDs, increasing its toxic effects.

Area of Science:

  • Dermatology
  • Rheumatology
  • Infectious Diseases

Background:

  • Methotrexate is a common treatment for psoriasis and psoriatic arthritis.
  • Non-steroidal anti-inflammatory drugs (NSAIDs) are often used concurrently for symptom management.

Observation:

  • A case of Pneumocystis carinii pneumonia (PCP) occurred in a patient receiving low-dose methotrexate.
  • The patient had a history of psoriasis and psoriatic arthropathy.

Findings:

  • The PCP was a potentially fatal complication of methotrexate therapy.
  • Drug interaction between methotrexate and NSAIDs likely potentiated methotrexate's toxicity.

Implications:

  • Clinicians should be aware of the increased risk of PCP when combining methotrexate with NSAIDs.
  • Careful monitoring for opportunistic infections is crucial in patients on this drug combination.
  • Alternative pain management strategies may be considered for patients on methotrexate therapy.

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