Endoalveolar haemorrhage due to methotrexate overdosage in a patient treated for psoriatic arthritis

Abstract

There are no previous reports of adverse pulmonary reactions in psoriatic patients treated for a long time with low dosages of methotrexate (MTX). We successfully treated a 57-year-old woman, affected with psoriasis and psoriatic arthritis, with 7.5 mg/week MTX for 24 months. One year later the patient herself, without any medical supervision, took 7.5 mg MTX every day instead of once a week, for a period of 15 days, after which she developed a nonproductive cough, increasing dyspnoea and fever. We discontinued MTX and introduced antibiotic therapy. The clinical course was unchanged. Chest radiograph, HRCT, bronchoalveolar lavage and transbronchial biopsy demonstrated haemosiderosis and focal mild fibrosis. The diagnosis was pulmonary adverse reaction to MTX. Corticosteroid therapy was introduced which produced a rapid clinical improvement. We describe this side-effect, never seen before, emphasizing that it occurred as a result of excessiveovertreatment.