Radiological and Pathological Manifestations of Methotrexate-Induced Acute Respiratory Distress Syndrome: A Case Report

Ching-Ying Huang ； Patricia Wanping Wu ； Yon-Cheong Wong

《Journal of Radiological Science》 47卷 (2022/03) Pp. 85-88

https://doi.org/10.6698/JRS.202203_47.0017

摘要

Pneumonitis is an uncommon but life-threatening side effect of methotrexate treatment. The main histopathological features of methotrexate-induced pneumonitis are nonspecific interstitial pneumonia and bronchiolitis obliterans organizing pneumonia. Diffuse alveolar damage is rare and is associated with a poor prognosis. We present a case of methotrexate-induced acute respiratory distress syndrome in a patient with psoriasis treated with low-dose methotrexate. High-resolution computed tomography demonstrated diffuse consolidation and ground-glass opacity in the bilateral lungs. Open lung biopsy revealed the histopathology to be diffuse alveolar damage. The patient was successfully treated with methotrexate discontinuation, mechanical ventilation, methylprednisolone, and extracorporeal membrane oxygenation.

關鍵字

methotrexate ； pneumonitis ； high-resolution computed tomography ； diffuse alveolar damage