A Case of Hypersensitivity Pneumonitis Caused by Methotrexate.

Suh, Hyun Joo; Park, Eun Ha; Chung, Man Pyo; Shin, Sung Chul; Jeon, Kyeong Man; Yu, Chang Min; Pyun, Yu Jang; Lee, Kyung Soo; Han, Joungho

doi:2004.56.2.203

Tuberc Respir Dis > Volume 56(2); 2004 > Article

Case Report

Tuberculosis and Respiratory Diseases 2004;56(2):203-209.
DOI: https://doi.org/10.4046/trd.2004.56.2.203 Published online February 1, 2004.

A Case of Hypersensitivity Pneumonitis Caused by Methotrexate.

Hyun Joo Suh, Eun Ha Park, Man Pyo Chung, Sung Chul Shin, Kyeong Man Jeon, Chang Min Yu, Yu Jang Pyun, Kyung Soo Lee, Joungho Han

¹Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Ilwon-Dong, Kangnam-Ku, Seoul, Korea. mpchung@smc.samsung.co.kr
²Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Ilwon-Dong, Kangnam-Ku, Seoul, Korea.
³Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Ilwon-Dong, Kangnam-Ku, Seoul, Korea.

Abstract

BACKGROUND
Methotrexate (MTX) has been used to treat a wide range of malignant and benign diseases including osteosarcoma, advanced stage non-Hodgkin's lymphoma, psoriasis, severe rheumatoid arthritis, sarcoidosis, and Wegener's granulomatosis. MTX-induced lung injury occurs in up to 10% of treated patients. Although both acute and chronic presentations have been described, typical manifestation of MTX-induced lung injury is subacute with symptoms usually developing within several months after starting therapy. Nonspecific interstitial pneumonia (NSIP) is the most common histopathologic manifestation of MTX-induced lung disease, while bronchiolitis obliterans organizing pneumonia (BOOP) and diffuse alveolar damage (DAD) are less common. Granuloma formation is reported in 34.7%. In Korea, Two reports of MTX pneumonitis have been published. The one presented with NSIP and the other with DAD. We recently experienced a case of MTX pneumonitis with presentation of hypersensitivity pneumonitis.

Key Words: Methotrexate, Hypersensitivity pneumonitis