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methotrexate pneumonitis

Mashal Salehi, Robertha Miller, Myint Khaing
BACKGROUND: Methotrexate has been implicated in a variety of lung complications, one of which is hypersensitivity pneumonitis. Hypersensitivity pneumonitis most often occurs within the first year of starting low-dose orally administered methotrexate. We present a case of methotrexate-induced hypersensitivity pneumonitis after 30 years of methotrexate use, which is the first case to be reported so far. CASE PRESENTATION: A 77-year-old African American woman with a history of rheumatoid arthritis presented with progressively worsening shortness of breath and nonproductive cough...
June 28, 2017: Journal of Medical Case Reports
Hiroshi Furukawa, Shomi Oka, Kota Shimada, Naoyuki Tsuchiya, Shigeto Tohma
No abstract text is available yet for this article.
May 12, 2017: Annals of the Rheumatic Diseases
Ramya Iyyadurai, Ronald Albert Benton Carey, Sowmya Satyendra
Methotrexate (MTX) is an antimetabolite used as a disease-modifying agent for various rheumatological conditions. We report two patients who were treated with daily low-dose MTX and developed acute interstitial pneumonitis requiring hospital admission. MTX-induced pneumonitis is a rare life-threatening side effect, high index of clinical suspicion is required, treatment is mainly withdrawal of MTX, supportive therapy, and adjunctive steroids, outcome is good if condition is recognized early, and appropriate treatment is given...
October 2016: Journal of Family Medicine and Primary Care
R J Rodenburg, M J H Wijnands, P L Rensma
Methotrexate is a frequently prescribed drug and is considered to be safe at a low dosage. However, serious complications may occur during treatment. In this article we describe a 78-year-old male who used low-dose methotrexate for psoriatic arthritis. He died of multi-organ failure caused by sepsis and methotrexate intoxication as a result of deteriorating renal function. The second patient was a 56-year-old male who used low-dose methotrexate for rheumatoid arthritis. This patient developed pancytopenia and methotrexate pneumonitis during treatment with methotrexate...
2017: Nederlands Tijdschrift Voor Geneeskunde
Hirotsugu Ohkubo, Minami Okayama, Kensuke Fukumitsu, Akio Niimi
A 59-year-old woman receiving methotrexate and tacrolimus for rheumatoid arthritis (RA) was referred to our hospital following bilateral ground-glass opacity observed in her chest X-ray and elevated serum KL-6. After methotrexate and tacrolimus cessation, shortness of breath developed and ground-glass opacity observed in the chest computed tomography rapidly worsened. Bronchoalveolar lavage showed increased lymphocytes, and trans-bronchial lung biopsy confirmed lymphocytic alveolitis. In addition, the patient had serum antibodies against Trichosporon asahii, a fungal pathogen...
November 2016: Respirology Case Reports
Camila Cabello Zurita, Mercè Grau Pérez, Carlos Pelayo Hernández Fernández, Alicia González Quesada, Pedro Valerón Almazán, Jaime Vilar Alejo, Gregorio Carretero Hernández
BACKGROUND: Methotrexate (MTX), a traditional antipsoriatic drug, is very frequently used either as monotherapy or in combination with other systemic drugs. OBJECTIVES: To assess the effectiveness and safety of MTX in psoriasis in usual clinical practice. METHODS: We conducted a retrospective study. We performed an electronic and manual chart review of patients treated with MTX in the Psoriasis Unit of our Hospital from January 2007 to December 2014...
January 9, 2017: Journal of Dermatological Treatment
Clarissa C M Valões, Glaucia V Novak, Juliana B Brunelli, Katia T Kozu, Ricardo K Toma, Clovis A Silva
OBJECTIVE: To assess esophageal involvement (EI) in juvenile localized scleroderma (JLS) population and the possible association between this gastrointestinal manifestation and demographic data, clinical features, laboratory exams, treatments and outcomes. METHODS: For a period of 31 years, 5,881 patients with rheumatic diseases were followed in our Pediatric Rheumatology Division. EI was defined by the presence of symptoms (solid/liquid dysphagia, heartburn, esophageal regurgitation, nausea/vomiting and epigastralgia) and confirmed by at least one EI exam abnormality: barium contrast radiography, upper gastrointestinal endoscopy and 24-hour esophageal pH-monitoring...
September 17, 2016: Revista Brasileira de Reumatologia
Laura C Cappelli, Anna Kristina Gutierrez, Alan N Baer, Jemima Albayda, Rebecca L Manno, Uzma Haque, Evan J Lipson, Karen B Bleich, Ami A Shah, Jarushka Naidoo, Julie R Brahmer, Dung Le, Clifton O Bingham
OBJECTIVES: Immune checkpoint inhibitors (ICIs) targeting the cytotoxic T-lymphocyte-associated protein 4 (CTLA-4) and programmed cell death protein 1 (PD-1) pathways have demonstrated survival improvements in multiple advanced cancers, but also cause immune-related adverse events (IRAEs). IRAEs with clinical features similar to rheumatic diseases have not been well described. We report patients with inflammatory arthritis and sicca syndrome secondary to ICIs. METHODS: We report patients evaluated in the Johns Hopkins Rheumatology clinics from 2012 to 2016 identified as having new rheumatological symptoms in the context of treatment with ipilimumab (anti-CTLA-4) and/or nivolumab (anti-PD-1) for solid tumours...
January 2017: Annals of the Rheumatic Diseases
Clara Sangüesa Gómez, Bryan Josué Flores Robles, Beatriz Jara Chinarro, María Espinosa Malpartida, Carmen Barbadillo Mateos
Pulmonary involvement in the form of acute pneumonitis in adult-onset Still's disease (AOSD) is an uncommon manifestation, with few cases reported in the literature. We report the case of a 61-year-old male with 3 years of AOSD evolution, treated with methotrexate (MTX) and half-dose corticosteroids, which debuted with symptoms of fever, dyspnea and dry cough after 3 weeks of receiving the first dose of tocilizumab (TCZ). In the follow-up study showed leukocytosis with left shift, elevated serum ferritin and C-reactive protein standard...
November 2016: Reumatología Clinica
Guillermo Enrique Vergara, Natalia Roura, Marcelo Del Castillo, Andrea Mora, Santiago Condomi Alcorta, Rubén Mormandi, Andrés Cervio, Jorge Salvat
BACKGROUND: Invasive aspergillosis (IA) of the central nervous system (CNS) is an uncommon condition that usually occurs in immunocompromised patients. This illness can manifest as meningitis, or as a micotic aneurism, stroke or abscess. The infection affects the CNS either primarily or, more often, secondarily via blood dissemination from a distant focus, and has a poor prognosis. We present a patient with IA primarily affecting the cervical bones, with later spread into the brain. CASE DESCRIPTION: A 25-year old male was receiving chemotherapy for acute lymphocytic leukemia when he developed pneumonitis secondary to methotrexate and was started on corticosteroids...
2015: Surgical Neurology International
Itishree Trivedi, Rishi Raj, Stephen Hanauer
No abstract text is available yet for this article.
March 2016: Clinical Gastroenterology and Hepatology
Françoise Fayet, Carine Savel, Malory Rodere, Bruno Pereira, Dihya Abdi, Sylvain Mathieu, Anne Tournadre, Martin Soubrier, Jean-Jacques Dubost
AIMS AND OBJECTIVES: Assess knowledge concerning methotrexate in rheumatoid arthritis patients by means of a questionnaire. BACKGROUND: Methotrexate is the standard drug for rheumatoid arthritis treatment. It has potentially serious side effects that can be largely prevented by making sure that patients are well informed and comply with prescription guidelines. DESIGN: Cross-sectional survey. METHODS: A questionnaire on methotrexate (mode of action, administration, drug interactions), side effects, monitoring and lifestyle implications was offered to all the rheumatoid arthritis patients treated with the drug seen between March and September 2013 in a large hospital in France...
March 2016: Journal of Clinical Nursing
Haibo Liu, Fang Liu, Min Zhang, Wenliang Yan, Hong Sang
Methotrexate has been widely used for many years in the treatment of a variety of diseases. Acute pneumonitis and bone marrow suppression are very serious side effects in methotrexate treatment. A 48-year-old man with end-stage renal disease undergoing chronic hemodialysis developed combined acute pneumonitis and pancytopenia after a cumulative dose of 20 mg methotrexate for bullous pemphigoid. Continuous renal replacement therapy (CRRT) can efficiently decrease serum methotrexate concentration. A rapid improvement of clinical symptoms and resolution of pulmonary opacification were found after CRRT...
May 2015: Anais Brasileiros de Dermatologia
Takashi Yoshida, Shigeru Kusumoto, Arisa Masuda, Haruhito Totani, Tomoko Narita, Ayako Masaki, Asahi Ito, Masaki Ri, Takashi Ishida, Hirokazu Komatsu, Shinsuke Iida
Reduced-intensity conditioning (RIC) has been shown to facilitate allogeneichematopoieticstem cell transplantation (allo-HSCT) for patients with comorbidities and the elderly. However, there are some concerns about transplant-related mortality (TRM). We retrospectively analyzed 37 consecutive patients who received allo-HSCT using RIC from January 2005 to December 2012 in our hospital. All patients received fludarabine(FLU), 180 mg/m2, and intravenous busulfan(BU), 6.4 mg/ kg (or oral BU 8 mg/kg), with or without TBI (2 or 4 Gy)...
June 2015: Gan to Kagaku Ryoho. Cancer & Chemotherapy
Christoph Fiehn
Although rheumatoid arthritis (RA) mainly manifests as polyarthritis, there is growing evidence that the initiation of the pathological immune reaction against citrullinated peptides takes place in the lung. However, in spite of this important role of the lung in pathophysiology, clinically manifest lung involvement has been demonstrated only in about 2-5 % of the patients with RA, and therefore is relatively rare. In particular the severe interstitial lung involvement with histological pattern of usual interstitial pneumonia has a bad prognosis and an increased mortality...
June 2015: Deutsche Medizinische Wochenschrift
Jennifer Wang, Curtis A Pettaway, Lance C Pagliaro
OBJECTIVE: To retrospectively estimate the efficacy of various treatments used in men with metastatic penile cancer that progresses after first-line chemotherapy. METHODS: Patients were from a 30-patient cohort with stage TxN2-3M0 penile squamous cell carcinoma treated with neoadjuvant paclitaxel, ifosfamide, and cisplatin chemotherapy before planned lymphadenectomy. Nineteen patients (63.3%) had tumor progression or recurrence, and we evaluated the response to subsequent treatment and survival...
May 2015: Urology
Hideaki Yamakawa, Masahiro Yoshida, Masamichi Takagi, Kazuyoshi Kuwano
A 61-year-old woman being treated with methotrexate (MTX) 8-10 mg/week and prednisolone 2.5 mg/day for rheumatoid arthritis presented with a 1-week history of increasing fever and dry cough. The patient deteriorated with administration of antibiotics. Chest CT scan showed bilateral diffuse ground-glass opacities. Analysis of bronchoalveolar lavage fluid (BALF) revealed marked neutrophilia (65.2% of total cells). The specimen from transbronchial lung biopsy showed a non-specific interstitial pneumonia pattern...
2014: BMJ Case Reports
Rebecca A Marsh, Jack J Bleesing, Shanmuganathan Chandrakasan, Michael B Jordan, Stella M Davies, Alexandra H Filipovich
X-linked lymphoproliferative disease type 1 (XLP1) is a rare immune deficiency caused by mutations in SH2D1A. Allogeneic hematopoietic cell transplantation (HCT) is often performed because of the morbidity and mortality associated with XLP1. There is limited experience using reduced-intensity conditioning (RIC) regimens for these patients. Here we report our 8-year single-center experience. Sixteen consecutive patients diagnosed with XLP1 underwent allogeneic HCT between 2006 and 2013 after a RIC regimen consisting of alemtuzumab, fludarabine, and melphalan...
October 2014: Biology of Blood and Marrow Transplantation
Yuan-Chang Liu, Yu-Ling Tu, Ren-Chin Wu, Jing-Long Huang, Tsung-Chieh Yao
Methotrexate, a drug commonly used to treat juvenile idiopathic arthritis (JIA), has been reported to cause interstitial pneumonitis as a rare complication in adults with rheumatoid arthritis. Only 1 suspicious case of methotrexate pneumonitis in a child with JIA has been reported in 1998, though with no histopathologic proof. Given its rarity and nonspecific presenting symptoms, diagnosis may be challenging, and a life-threatening illness can occur without a high index of suspicion, as illustrated by this report of a 13-year-old girl with JIA who developed fever, nonproductive cough, and dyspnea as presenting features of interstitial pneumonitis after 1 year of methotrexate therapy...
June 2014: Pediatric Emergency Care
Richard Conway, Candice Low, Robert J Coughlan, Martin J O'Donnell, John J Carey
OBJECTIVE: Methotrexate has shown efficacy for the treatment of several diseases, especially rheumatoid arthritis (RA). Methotrexate has also been implicated as a causative agent in interstitial lung disease. Patients with RA may develop pulmonary manifestations of their disease and are at increased risk of respiratory infection. The aim of this study was to evaluate the relative risk (RR) of pulmonary disease among patients with RA treated with methotrexate. METHODS: We searched the PubMed and Cochrane databases (publication dates January 1, 1990 to February 1, 2013) for double-blind, randomized, controlled trials of methotrexate versus placebo or active comparator agents in adults with RA...
April 2014: Arthritis & Rheumatology
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