Richard L. Leff, MD; John P. Case, MD; Robin McKenzie, MD
To the Editor: Low-dose methotrexate therapy has a 1% to 5% incidence of pneumonitis (1). However, Pneumocystis carinii pneumonia resembling methotrexate-induced pneumonitis has been reported (2, 3) in two patients. In both cases, concomitant low-dose daily corticosteroids may have contributed to immunosuppression. We report a case of P. carinii pneumonia in a patient with rheumatoid arthritis who was treated with low-dose methotrexate without corticosteroids.
A 66-year-old man with rheumatoid arthritis presented with progressive cough, fever, and shortness of breath. Methotrexate therapy had been started 6 months earlier, up to 22.5 mg/wk, with marked improvement in his rheumatoid arthritis. A stable
Leff RL, Case JP, McKenzie R. Rheumatoid Arthritis, Methotrexate Therapy, and Pneumocystis Pneumonia. Ann Intern Med. ;112:716. doi: 10.7326/0003-4819-112-9-716_1
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Published: Ann Intern Med. 1990;112(9):716.
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