Methotrexate pneumonitis: review of the literature and histopathological findings in nine patients
Methotrexate pneumonitis: review of the literature and histopathological findings in nine patients
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DOI：
10.1034/j.1399-3003.2000.15b25.x
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发表时间：
2000-02-01
影响因子：
24.3
通讯作者：
Helmers, RA
中科院分区：
文献类型：
--
作者：
Imokawa, S;Colby, TV;Helmers, RA
甲氨蝶呤（MTX）治疗的严重和不可预测的副作用，可能会危及生命。本文报告9例甲氨蝶呤（MTX）肺炎的临床和组织学特点，典型的临床症状为进行性呼吸急促和咳嗽，常伴发热，常伴有低氧血症和呼吸急促，常可闻及爆裂音，胸片表现为弥漫性或混合性间质和肺泡浸润，好发于下肺野。肺功能检查显示弥散能力降低的限制性模式，肺活检显示细胞间质浸润、肉芽肿或弥漫性肺泡损伤模式伴血管周围炎症，这些临床和病理学结果并不特异于MTX肺炎，也可以在其他药物中观察到。重要的是，所有接受甲氨蝶呤的患者都应了解这种潜在的不良反应，并指导他们联系他们的医生。如果怀疑甲氨蝶呤肺炎，应停用甲氨蝶呤，采取支持性措施，并仔细检查不同原因的呼吸窘迫。
Pneumonitis is a serious and unpredictable side-effect of treatment with methotrexate (MTX) that may become life-threatening. The clinical and histological features of nine cases of MTX pneumonitis are reported and the literature reviewed.The typical clinical symptoms include progressive shortness of breath and cough, often associated with fever, Hypoxaemia and tachypnoea are always present and crackles are frequently audible, Chest radiography reveals a diffuse interstitial or mixed interstitial and alveolar infiltrate, with a predilection for the lower lung fields. Pulmonary function tests show a restrictive pattern with diminished diffusion capacity, Lung biopsy reveals cellular interstitial infiltrates, granulomas or a diffuse alveolar damage pattern accompanied by perivascular inflammation, These clinical and pathological findings are not specific to MTX pneumonitis and can be seen with other drug-induced lung toxicities.It is important that all patients receiving methotrexate be educated concerning this potential adverse reaction and instructed to contact their physicians should significant new pulmonary symptoms develop while undergoing therapy, If methotrexate pneumonitis is suspected, methotrexate should be discontinued, supportive measures instituted and careful examination for different causes of respiratory distress conducted.