Brief Discussion

Methotrexate (MTX)
- Folic acid antagonist that inhibits cellular reproduction
- Treatment of malignancy
- Low dose: psoriasis, pemphigus, asthma, primary biliary cirrhosis, inflammatory bowel disease, rheumatoid arthritis

MTX induced lung injury
- Acute hypersensitivity pneumonitis and respiratory failure
- Subacute cellular interstitial pneumonitis
- Pulmonary infiltrates and eosinophilia
- Pulmonary fibrosis
- Acute pulmonary edema
- Acute permeability edema with or without ARDS
- Alveolar hemorrhage (1 case)
- Bronchospasm? laryngeal edema and anaphylactic shock
- Pleural effusion
- Chest pain
- Opportunistic infectious pneumonia

MTX pneumonitis
- Usually reversible, presumably as a result of hypersensitivity reaction, but chronic interstitial fibrosis, NSIP, BOOP can develop.
- Symptoms and signs of toxicity: days to several years after initiation of therapy

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