Two rare cases of methotrexate-induced pneumonitis and pleurisy in patients with gestational trophoblastic neoplasms

Background: Pneumonitis is a serious and unpredictable side-effect of treatment with methotrexate (MTX) that may result in a life-threatening outcome. Pulmonary toxicity of methotrexate in patients with a gestational trophoblastic neoplasm (GTN) has rarely been reported before. Case Reports: For the first time two cases of methotrexate-induced pneumonitis and pleurisy in GTN patients of Chinese ethnicity are presented. Two patients were both categorized as the low-risk group, and underwent a single regimen therapy of methotrexate. Their symptoms, such as fever, chest pain, acute nonproductive cough, dyspnea and hypoxemia did not respond to antibiotics immediately. Treatment with corticosteroids may be helpful. Conclusion: Awareness of pneumonitis and pleurisy, potentially lifethreatening complications of MTX, is very necessary and important to early recognition and treatment.

Methotrexate; Pneumonitis; Pleurisy; Gestational trophoblastic neoplasm

[1] Zisman D.A., McCune W.J., Tino G., Lynch J.P. 3rd.: “Druginduced pneumonitis: the role of methotrexate”. Sarcoidosis Vasc. Diffuse Lung Dis., 2001, 18, 243.

[2] Christophe B., Leila A., Christophe S., Jean-Sebastien A., Jeanlouis R., Yann L.: “Respiratory failure due to Pneumocystis carinii following methotrexate therapy for gestational trophoblastic disease”. Br. J. Obstet. Gynecol., 2005, 112, 382.

[3] Cannon G.W.: “Methotrexate pulmonary toxicity”. Rheum. Dis. Clin. North Am., 1997, 23, 917.

[4] Imokawa S., Colby T.V., Leslie K.O., Helmers R.A.: “Methotrexate pneumonitis review of the literature and histopathological findings in nine patients”. Eur. Respir. J., 2000, 15, 373.

[5] Shimizu Y., Tsukagoshi H., Nemoto T., Honma M., Nojima Y., Mori M.: “Effect of methotrexate on pulmonary function in patients with rheumatoid arthritis: a prospective study”. Rheumatol. Int., 2002, 22, 204.

[6] Mazokopakis E., Katsogridakis K., Koutsopoulos A., Voloudaki A., Froudarakis M., Kritikos H. et al.: “Fatal methotrexate-induced pneumonitis in a psoriatic patient”. Mil. Med., 2004, 169, 298.

[7] Tatsumoto C., Kawakami K., Nagayama J., Kawano H.: “Methotrexate-induced interstitial pneumonitis in a child with acute lymphoblastic leukemia”. Rinsho. Ketsueki., 2004, 45, 1100.

[8] Cho I., Mori S., Imamura F., Kiyofuji C., Sugimoto M.: “Methotrexate pneumonia lacking dyspnea and radiographic interstitial patterns during treatment for early rheumatoid arthritis: bronchoalveolar lavage and transbronchial lung biopsy in a differential diagnosis”. Mod. Rheumatol., 2007, 17, 256.

[9] Ozawa Y., Ida M., Suda T., Katou M., Enomoto N., Fujii M. et al.: “A case of subacute idiopathic interstitial pneumonia resistant to steroids, successfully treated with cyclophosphamide”. Nihon. Kokyuki. Gakkai. Zasshi., 2004, 42, 945.