Department of Rheumatology, P.D. Hinduja National Hospital and Medical Research Centre, Veer Savarkar Marg, Mahim, Mumbai, Maharashtra, India.
J Postgrad Med. 2022 Jul-Sep;68(3):170-175. doi: 10.4103/jpgm.jpgm_1180_21.
Methotrexate leading to hypercalcaemia is a rarely reported adverse event. We present three elderly patients with inflammatory arthritis who developed hypercalcemia probably due to methotrexate-induced granulomatous pneumonitis. All patients presented with worsening non-productive cough with dyspnea, nausea, loss of appetite, and confusion. Their clinical and radiologic features were consistent with methotrexate-induced pneumonitis. On evaluation, all patients concurrently had hypercalcemia with normal 25OH D3, and low PTH with markedly elevated levels of 1,25OH D3 seen in two patients. In all three patients, hypercalcemia and pneumonia responded to hydration, corticosteroids, and methotrexate withdrawal. There was no relapse of symptoms on long term follow-up. In these three patients with inflammatory arthritis, methotrexate-induced pneumonitis led to symptomatic hypercalcemia. Unless hypercalcemia is looked for and treated in this setting, the morbidity can be high.
甲氨蝶呤导致高钙血症是一种罕见的不良反应。我们报告了 3 例老年炎症性关节炎患者，他们可能因甲氨蝶呤引起的肉芽肿性肺炎而发生高钙血症。所有患者均出现恶化的非生产性咳嗽伴呼吸困难、恶心、食欲不振和意识模糊。他们的临床和影像学特征与甲氨蝶呤诱导的肺炎一致。在评估中，所有患者同时伴有高钙血症，25OH D3 正常，甲状旁腺激素（PTH）低，2 例患者 1,25OH D3 水平显著升高。在这 3 例炎症性关节炎患者中，高钙血症和肺炎对水化、皮质类固醇和甲氨蝶呤停药有反应。长期随访中没有症状复发。在这 3 例炎症性关节炎患者中，甲氨蝶呤诱导的肺炎导致了症状性高钙血症。如果不在这种情况下寻找和治疗高钙血症，发病率可能会很高。
