Tsai J J, Shin J F, Chen C H, Wang S R
Section of Allergy, Immunology and Rheumatology, Veterans General Hospital-Taipei, Taiwan.
Int Arch Allergy Immunol. 1993;100(3):287-90. doi: 10.1159/000236426.
Methotrexate pneumonitis is one of the most unpredictable and potentially serious adverse effects associated with the use of low-dose pulse methotrexate in treating rheumatoid arthritis. However, its occurrence in treating bronchial asthma has never been reported. A patient with steroid-dependent bronchial asthma developed interstitial pneumonitis during methotrexate therapy. Dyspnea, fever and oral ulcer occurred successively during the initial 4 months of intermittent low-dose methotrexate pulse therapy. Despite severe hypoxemia and interstitial infiltration in both lung fields, the lung lesions disappeared after treatment with corticosteroid and discontinuation of methotrexate therapy. In conclusion, methotrexate pneumonitis might develop after treatment. Once pneumonitis is suspected, methotrexate should be withdrawn.
甲氨蝶呤肺炎是使用低剂量脉冲甲氨蝶呤治疗类风湿关节炎时最难以预测且可能严重的不良反应之一。然而，其在治疗支气管哮喘时的发生情况此前从未有过报道。一名依赖激素的支气管哮喘患者在甲氨蝶呤治疗期间发生了间质性肺炎。在间歇性低剂量甲氨蝶呤脉冲治疗的最初4个月内，患者相继出现呼吸困难、发热和口腔溃疡。尽管存在严重低氧血症且双肺野有间质浸润，但在使用皮质类固醇治疗并停用甲氨蝶呤后，肺部病变消失。总之，治疗后可能会发生甲氨蝶呤肺炎。一旦怀疑有肺炎，应停用甲氨蝶呤。
