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Noncardiogenic pulmonary edema following injection of methotrexate into the cerebrospinal fluid
Abstract:
The most common pulmonary disorder induced by methotrexate is a gradually developing interstitial pneumonitis. The associated clinical manifestations include slowly progressive dyspnea and nonproductive cough, with extensive radiographic changes. One case has been reported following intrathecal methotrexate administration; the remainder occurred after either intravenous or oral therapy. We report two cases of rapidly developing respiratory distress following the administration of methotrexate into the cerebrospinal fluid. The clinical courses, radiologic findings, and, in one patient, the pathologic nature, are consistent with noncardiogenic pulmonary edema.
Insights
Methotrexate can cause lung injury. Rapid respiratory distress after intrathecal methotrexate suggests noncardiogenic pulmonary edema, a rare but serious side effect.
Area of Science:
- Pulmonology
- Oncology
- Pharmacology
Background:
- Methotrexate is a common chemotherapy agent.
- Methotrexate-induced lung disease (MILD) typically presents as interstitial pneumonitis.
- MILD usually develops gradually after oral or intravenous administration.
Observation:
- A rare case of MILD following intrathecal methotrexate was previously reported.
- We present two cases of acute respiratory distress after intrathecal methotrexate.
- Clinical and pathological findings suggest noncardiogenic pulmonary edema.
Findings:
- Intrathecal methotrexate can cause rapidly progressing respiratory distress.
- This presentation is consistent with noncardiogenic pulmonary edema.
- Pathologic findings in one patient confirmed pulmonary edema.
Implications:
- Clinicians should consider noncardiogenic pulmonary edema in patients with respiratory distress after intrathecal methotrexate.
- Early recognition and management are crucial for improving patient outcomes.
- This highlights a potentially severe adverse effect of intrathecal methotrexate administration.