Interstitial pneumonia methotrexate

Yoshida S, Onuma K, Akahori K, Sakamoto H, Yamawaki Y, Shoji T, Nakagawa H, Hasegawa H, Amayasu H. Elevated levels of lL-8 in interstitial pneumonia induced by low-dose methotrexate. J Allergy Clin Immunol 1999 103(5 Pt l) 952-4. 

In patients with definite or probable methotrexate-induced lung injury, the predominant clinical features include shortness of breath, cough, and fever (13). Pathological examination usually shows an interstitial inflammatory cell infiltrate (sometimes granulomatous or with alveolar damage), and variable degrees of interstitial fibrosis. Unfortunately, confirmatory evidence is sometimes hard to obtain, particularly in patients with rheumatoid arthritis in whom rheumatoid interstitial lung disease can also occur. Infectious pneumonias, particularly viral or Pneumocystis jiroveci pneumonia, which resemble methotrexate pneumonitis and can occur as a result of immunosuppression, should also be carefully excluded. 

Acute and chronic effects of methotrexate on hepatic, pulmonary and skeletal systems have been reviewed in a series of children (59. Acute methotrexate toxicity in addition to the effects already mentioned on the gut and bone marrow, was experienced in the lung. Pulmonary reactions were seen in 30 of 252 children. The pneumonia was characteristically bilateral and interstitial. No organisms were isolated at the time of the illness. Nine of the patients had lung biopsies and in 3 of these Pneumocystis catinii was found. No cause could be seen in 6 other patients and it was thought that the... 

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