ab17_3

Rheumatoid arthritis associated with methotrexate-induced pneumonitis: Improvement with i.v. cyclophosphamide therapy

A. Suwa¹, M. Hirakata¹, S. Satoh¹, T. Mimori1, K. Utsumi², S. Inada³

¹Department of Internal Medicine, Keio University School of Medicine; ²Division of Internal Medicine and ³Division of Rheumatic Diseases, Tokyo Metropolitan Ohtsuka Hospital, Tokyo, Japan.

ABSTRACT
Pneumonitis is one of the most serious adverse effects associated with low-dose weekly methotrexate (MTX) therapy. Immediate cessation of MTX, and the introduction of oxygen therapy and glucocorticoids usually results in a dramatic improvement in the pulmonary toxicity. We report here a case of MTX-induced pneumonitis in a patient with rheumatoid arthritis (RA). Severe hypoxemia and interstitial infiltration in both lung fields did not respond to the withdrawal of MTX and the administration of oxygen and steroid pulse therapy. When intravenous cyclophosphamide (CYC) pulse therapy was initiated, however, rapid physiologic and radiographic improvement was seen. Our case suggests that CYC treatment may have a beneficial effect on MTX-induced pneumonitis that is resistant to steroid therapy.

Key words
Cyclophosphamide, interstitial pneumonitis, methotrexate, rheumatoid arthritis.

Please address correspondence and reprint requests to: Akira Suwa, MD, Department of Internal Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan.