Fujimori Taichi, Sano Chiaki, Ohta Ryuichi
Community Care, Unnan City Hospital, Unnan, JPN.
Community Medicine Management, Shimane University Faculty of Medicine, Izumo, JPN.
Cureus. 2024 Apr 20;16(4):e58659. doi: 10.7759/cureus.58659. eCollection 2024 Apr.
Methotrexate (MTX), a cornerstone treatment for rheumatoid arthritis (RA), is associated with drug-induced hypersensitivity syndrome (DIHS), including rare instances of methotrexate-induced pneumonitis. We report a significant case of a 65-year-old woman with RA, treated with MTX for over two decades, who presented with fever, headache, nausea, and malaise and was later diagnosed with DIHS, manifesting as pneumonitis and hepatosplenomegaly. Despite initial suspicion of bacterial pneumonia, her condition deteriorated, leading to the consideration of DIHS. The diagnosis was confirmed through a drug lymphocyte stimulation test (DLST), and she responded well to prednisolone. This case underlines the complexity of long-term MTX therapy, emphasizing the need for vigilance towards DIHS even after years of treatment. The findings prompt a reconsideration of ongoing treatments for RA, particularly in settings where long-term MTX use is prevalent. Early intervention and diagnostic tests like the DLST are crucial for preventing severe outcomes. This case adds to the growing evidence of MTX's potential for causing DIHS even in long-term usage. It stresses the importance of balancing therapeutic benefits with the risks of significant adverse reactions in stable RA patients.
甲氨蝶呤（MTX）是类风湿关节炎（RA）的一种基础治疗药物，与药物性超敏反应综合征（DIHS）有关，包括罕见的甲氨蝶呤诱发的肺炎病例。我们报告了一例65岁患有RA的女性的重要病例，她接受MTX治疗超过二十年，出现发热、头痛、恶心和不适，后来被诊断为DIHS，表现为肺炎和肝脾肿大。尽管最初怀疑是细菌性肺炎，但她的病情恶化，导致考虑DIHS。通过药物淋巴细胞刺激试验（DLST）确诊，她对泼尼松龙反应良好。该病例突显了长期MTX治疗的复杂性，强调即使经过多年治疗，也需要对DIHS保持警惕。这些发现促使重新考虑RA的现有治疗方法，特别是在长期使用MTX的情况下。早期干预和像DLST这样的诊断测试对于预防严重后果至关重要。该病例增加了越来越多的证据，表明即使长期使用MTX也有导致DIHS的可能性。它强调了在稳定的RA患者中平衡治疗益处与重大不良反应风险的重要性。
