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Cryptococcosis associated with low-dose methotrexate for arthritis
The American Journal of Medicine
|July 1, 1987
Summary
Low-dose methotrexate, used for psoriatic and rheumatoid arthritis, was linked to pulmonary cryptococcosis in two patients. This suggests methotrexate may be more immunosuppressive than previously thought, requiring careful evaluation for infections in patients with pneumonitis.
Area of Science:
- Rheumatology
- Infectious Diseases
- Pulmonology
Background:
- Methotrexate is a common disease-modifying antirheumatic drug (DMARD) used for inflammatory conditions like psoriatic arthritis and rheumatoid arthritis.
- Low-dose methotrexate regimens are generally considered to have a favorable safety profile regarding immunosuppression.
Observation:
- Two patients, one with psoriatic arthritis and another with rheumatoid arthritis, developed pulmonary cryptococcosis.
- Both patients had been receiving low-dose oral methotrexate (10-15 mg/week) for over a year prior to the onset of the fungal infection.
Findings:
- These cases represent the first reported instances of opportunistic fungal infections, specifically pulmonary cryptococcosis, occurring during low-dose methotrexate therapy.
- The development of cryptococcosis suggests that low-dose methotrexate may exert a more significant immunosuppressive effect than previously recognized.
Implications:
- Physicians should consider the potential for opportunistic infections in patients on long-term, low-dose methotrexate therapy.
- Patients presenting with pneumonitis while undergoing methotrexate treatment require thorough evaluation to exclude infectious etiologies, such as fungal infections.