Elsasser S, Dalquen P, Soler M, Perruchoud A P
Department of Internal Medicine, University Hospital, Basel, Switzerland.
Am Rev Respir Dis. 1989 Oct;140(4):1089-92. doi: 10.1164/ajrccm/140.4.1089.
A 71-year-old man with a long-standing history of rheumatoid arthritis required methotrexate treatment since 1986, with a total dose of 210 mg. In April 1987, before arthroplastic surgery, methotrexate was discontinued. Four weeks later a syndrome of fever, dry cough, shortness of breath, and diffuse air-space consolidations on the chest radiograph evolved. An antibiotic therapy had no beneficial effect, and a bronchoscopy yielded no pathogens. An open lung biopsy led to the diagnosis of methotrexate-induced pneumonitis. This is the first report of a case where methotrexate-induced pneumonitis developed several weeks after cessation of the treatment. Methotrexate can cause four types of pulmonary adverse reactions: pneumonitis, pulmonary edema, pulmonary fibrosis, and pleuritis. Possible pathogenetic mechanisms, symptoms, treatment, and prognosis are discussed.
一名71岁男性，有长期类风湿关节炎病史，自1986年起接受甲氨蝶呤治疗，总剂量为210毫克。1987年4月，在关节置换手术前停用了甲氨蝶呤。四周后，出现了发热、干咳、气短综合征，胸部X光片显示弥漫性气腔实变。抗生素治疗无效，支气管镜检查未发现病原体。开放性肺活检确诊为甲氨蝶呤诱发的肺炎。这是首例关于甲氨蝶呤诱发的肺炎在治疗停止数周后发生的病例报告。甲氨蝶呤可引起四种类型的肺部不良反应：肺炎、肺水肿、肺纤维化和胸膜炎。文中讨论了可能的发病机制、症状、治疗及预后。
