Lascari A D, Strano A J, Johnson W W, Collins J G
Cancer. 1977 Oct;40(4):1393-7. doi: 10.1002/1097-0142(197710)40:4<1393::aid-cncr2820400405>3.0.co;2-h.
A teenage girl in bone marrow remission with acute lymphocytic leukemia died suddenly from pulmonary edema. She had taken her first oral dose of methotrexate and cyclophosphamide 10 hours previously when she was feeling well and was asymptomatic. One week previously she had received the last of four intrathecal injections of methotrexate. Autopsy showed marked pulmonary edema as well as chronic lung changes, as previously described in patients with methotrexate pneumonitis. There is usually at least a 12-day interval from the onset of administration of methotrexate to the onset of the lung toxicity. The authors suggest the patient was sensitized by the intrathecal methotrexate and then reacted with angioneurotic edema of the lung when given the first oral dose of methotrexate. Careful examination for infectious agents, including electron microscopy, was negative.
一名处于急性淋巴细胞白血病骨髓缓解期的少女突然死于肺水肿。10小时前，她首次口服甲氨蝶呤和环磷酰胺，当时感觉良好且无症状。一周前，她接受了第四次鞘内注射甲氨蝶呤。尸检显示有明显的肺水肿以及慢性肺部改变，这与之前甲氨蝶呤肺炎患者中所描述的情况相同。从开始使用甲氨蝶呤到出现肺部毒性通常至少有12天的间隔期。作者认为该患者因鞘内注射甲氨蝶呤而致敏，随后在首次口服甲氨蝶呤时发生了肺部血管神经性水肿。包括电子显微镜检查在内的对感染病原体的仔细检查结果均为阴性。
