Abstract
TOPIC: Diffuse Lung Disease TYPE: Global Case Reports INTRODUCTION: Diffuse interstitial lung diseases are an heterogeneous group of respiratory diseases with difficult diagnosis. The study of bronchoalvolar lavage (BAL) by flow cytometry may define typical patterns in different diseases, providing some help in the differential diagnosis. CASE PRESENTATION: We report a case with an history of rheumatoid arthritis, who shows diffuse lung injury by chest x-ray.The bronchoalveolar lavage study showed an increase in lymphocyte subpopulations, specifically CD4 + lymphocytes (CD4 + / CD8 + ratio = 1.33), with respect to the values ??observed in blood. DISCUSSION: Metorexate is an antineoplastic and anti-inflammatory drug, who competitively inhibits dihydrofolate reductase, the enzyme that reduces folic acid to tetrahydrofolic acid, inhibiting DNA synthesis. One of the most common and serious adverse reactions described is acute interstitial pneumonitis, which progresses to pulmonary fibrosis in 10% of patients.Methotrexate pulmonary toxicity presents as lymphocytic alveolitis with an increased CD4 + / CD8 + ratio. In these cases, the immediate withdrawal of the drug corticosteroids administration are essential, leading to a rapid improvement in the patient's evolution. CONCLUSIONS: The study of BAL is helpful to discriminate between interstitial lung diseases. REFERENCE #1: Jakubovic BD, Donovan A, Webster PM, Shear NH. Methotrexate-induced pulmonary toxicity. Can Respir J. 2013;20(3):153-155. DISCLOSURES: No relevant relationships by Isabel Rodríguez Martín, source=Web Response
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