Methotrexate-induced pneumonitis in Crohn’s disease: Case report and review of the literature

Nadia D'Andrea; Luca Triolo; Giovanna Margagnoni; Annalisa Aratari; Claudio M. Sanguinetti

doi:10.4081/mrm.2010.558

Methotrexate-induced pneumonitis in Crohn’s disease

Case report and review of the literature

Authors

Nadia D'Andrea UOC Pneumologia, ACO San Filippo Neri, Roma
Luca Triolo Pneumology Unit, San Filippo Neri General Hospital, Rome
Giovanna Margagnoni Gastroenterology Unit, San Filippo Neri General Hospital, Rome
Annalisa Aratari Gastroenterology Unit, San Filippo Neri General Hospital, Rome
Claudio M. Sanguinetti Pneumology Unit, San Filippo Neri General Hospital, Rome

DOI: https://doi.org/10.4081/mrm.2010.558

Keywords:

Crohn’s disease, CT, methotrexate, pneumonitis, spirometry.

Abstract

Methotrexate (MTX) is a folate-antagonist used in several neoplastic and inflammatory diseases. Reports of pulmonary complications in patients given low-dose MTX therapy are increasing. Pulmonary toxicity from MTX has a variable fre- quency and can present with different forms. Most often MTX-induced pneumonia in patients affected by rheumatoid arthritis (RA) is reported. In this paper we describe a case of MTX-related pneumonitis in a relatively young woman affected by Crohn's disease who presented non-productive cough, fever and dyspnea on exer- cise. Chest X-ray demonstrated bilateral interstitial infil- trates and at computed tomography (CT) ground-glass opac- ities appeared in both lungs. At spirometry an obstructive defect was demonstrated. A rapid improvement of symptoms and the regression of radiographic and spirometric alter- ations was achieved through MTX withdrawal and the intro- duction of corticosteroid therapy.