Pulmonary disease complicating intermittent methotrexate therapy of psoriasis

A patient with psoriasis was treated with methotrexate (MTX) orally once a week. Bilateral pulmonary infiltrations, hilar- and peripheral adenopathy with granulomas, cough, fever and dyspnoea developed after 10 months of treatment. Similar symptoms in patients receiving MTX have been described by others. The clinical symptoms cleared after MTX was withdrawn. However, the radiographic changes persisted long after the symptoms had resolved. The possibility of sarcoidosis incidentally developing during the MTX treatment is discussed.