Methotrexate‐induced sudden fatal pulmonary reaction
Methotrexate‐induced sudden fatal pulmonary reaction
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甲氨蝶呤引起的突发致命肺部反应
作者：
A. Lascari;Alfonso J. Strano;W. Johnson;James G. P. Collins
一名患有急性淋巴细胞白血病的骨髓缓解期少女突然死于肺水肿。她在10小时前首次口服甲氨蝶呤和环磷酰胺，当时她感觉良好且无症状。一周前，她接受了四次甲氨蝶呤鞘内注射的最后一次。尸检显示明显的肺水肿以及慢性肺部变化，如前所述的患者甲氨蝶呤肺炎。从甲氨蝶呤给药开始至肺毒性发生通常至少间隔12天。作者认为，患者被鞘内注射甲氨蝶呤致敏，然后在首次口服甲氨蝶呤时发生肺血管神经性水肿。仔细检查感染因子，包括电子显微镜检查，结果为阴性。
A teenage girl in bone marrow remission with acute lymphocytic leukemia died suddenly from pulmonary edema. She had taken her first oral doses of methotrexate and cyclophosphamide 10 hours previously when she was feeling well and was asymptomatic. One week previously she had received the last of four intrathecal injections of methotrexate. Autopsy showed marked pulmonary edema as well as chronic lung changes, as previously described in patients with methotrexate pneumonitis. There is usually at least a 12‐day interval from the onset of administration of methotrexate to the onset of the lung toxicity. The authors suggest the patient was sensitized by the intrathecal methotrexate and then reacted with angioneurotic edema of the lung when given the first oral dose of methotrexate. Careful examination for infectious agents, including electron microscopy, was negative.