- 期刊
Methotrexate-Induced Hypersensitivity Pneumonitis in a Patient with Rheumatoid Arthritis-A Case Report
類風濕性關節炎病患使用Methotrexate所引致的過敏性肺炎－病例報告
摘要
暴露到許多種物質會引起過敏性肺炎。要區別過敏性肺炎和其他間質性肺病並不容易。診斷必須要結合暴露病史、症狀、影像學發現，以及病理學特徵。一旦診斷確立，要儘快投與類固醇並且避免繼續暴露到引發之物質。 我們報告一名患有類風濕性關節炎之59歲女性病志，其於門診長期接受數種藥物治療，其中包括低劑量的methotrexate。病人於入院前一星期呈現發燒、畏寒、乾咳、全身倦怠之徵狀且隨後出現持續性喘、缺氧，同時胸部X光及斷層掃描呈瀰漫性間質性浸潤且臨床徵象並不因廣泛性抗生素之使用而改善。由於病人有使用多種藥物之病史，經進一步的內視鏡肺切片之病理診斷為藥物引致之間質性肺炎，臨床徵象及間質性病變在使用了類固醇後明顯改善。由於風溼性關節炎治療藥物引致之間質性肺炎，methorexate為首要藥物且其發生常為特發性與使用之時間長短或劑量大小無相關性。因此，當病患有使用methorexate之病史且發生間質性肺炎時，須將藥物引起的過敏性肺炎刊入鑑別診斷。
並列摘要
Hypersensitivity pneumonitis is caused by exposure to a variety of agents. Differentiating hypersensitivity pneumonitis from other interstitial lung diseases is not easy. The diagnosis relies on a combination of exposure history, symptoms, radiological findings, and pathological characteristics. Once this diagnosis is made, corticosteroids should be administered as soon as possible, and exposure to the causative agent avoided. We report a 59-year-old woman with rheumatoid arthritis for 4 years, who was treated with several medications including methotrexate. She was admitted to our hospital with pneumonia, presenting with fever, chills, dry cough, and general malaise. Subsequently, she had increasing dyspnea, hypoxemia, and progressive diffuse interstitial pneumonia and fever, which persisted despite antibiotics treatment. Because she was taking methotrexate, methotrexate-induced pneumonitis was strongly suspected, and was later diagnosed after a series of studies. The patient improved dramatically after the steroid treatment, and she was discharged with complete resolution of the hypersensitivity pneumonitis. Methotrexate pneumonitis should be considered in patients treated with the drug and presenting with interstitial pneumonia.