Pneumotox » Drug » Methotrexate

Methotrexate

5

Last update : 13/07/2012

I.a Pneumonitis (ILD), acute and/or severe (may cause ARDS)

5

I.b Pneumonitis (ILD)

2

I.d Organizing pneumonia pattern (an area or areas of consolidation on imaging)

1

I.g Pulmonary fibrosis

1

I.h Subclinical pulmonary infiltrates/ILD

1

I.k Lung nodule or nodules

2

I.l Diffuse alveolar damage (DAD) (see alsoo under IIb and XVf)

2

I.m ILD with a granulomatous component

3

I.q Pulmonary nodulosis

2

I.v Abnormal lung function/pulmonary physiology (PFTs) without necessarily imaging or clinical evidence

-

I.w Rapidly progressive ILD/pulmonary fibrosis (Hamman-Rich syndrome)

1

I.aa Delayed ILD, -pneumonitis, -fibrosis

1

II.a Pulmonary edema, noncardiogenic (NCPE)

2

II.b ARDS - Acute lung injury

2

III.a Alveolar hemorrhage (AH), diffuse AH (DAH)

1

IV.a Bronchospasm - Wheezing - Asthma

1

IV.d Cough (lone)

1

V.a Pleural effusion (uni- or bilateral) (can accompany DI-LDs)

1

V.b Eosinophilic pleural effusion

1

V.e Hemothorax - Serosanguineous pleural effusion

1

V.i Pleuritis (can cause chest pain)

1

V.n Hemopericardium - Bloody pericardial effusion

1

V.s Serositis - Polyserositis

2

VI.a Pulmonary embolism - Venous thrombosis/thromboembolism

-

VII.a Lymphadenopathy (intrathoracic)

1

VIII.a Angioedema (may cause UAO, asphyxia and death)

1

VIII.aj Endobronchial lymphoproliferative disorder

1

X.f Anaphylaxis-Anaphylactoid reaction (can be fatal)

3

X.k Sarcoid-like granulomatosis (endo-/extrathoracic)

1

X.u Multiple organ dysfunction/failure (MODS/MOF)

1

XI.b Chest pain (acute or subacute), lone or prominent

1

XI.c Pleuritic chest pain

2

XII.c Pericardial effusion (w/wo tamponade)

1

XIII.b Lymphoproliferative disease (pulmonary, endobronchial, endothoracic)

2

XIII.g Lymphomatoid granulomatosis (pulmonary, endothoracic)

1

XIII.k Lymphoproliferative disease (extrathoracic)

1

XV.a Path: NSIP-cellular pattern (see also Ia, Ib)

3

XV.c Path: Organizing pneumonia (OP/BOOP) pattern (see also Id)

1

XV.e Path: ILD with a granulomatous component (see also Im)

3

XV.f Path: Diffuse alveolar damage (DAD-pattern) (see also IL)

1

XV.h Path: NSIP-fibrotic pattern

1

XV.i Path: Pneumocyte atypia (reactive epithelial cells) (a.k.a. the "Napoleon Hat" sign)

1

XV.w Path: Pulmonary edema (see also II/IIa)

1

XV.bq Path: Lymphoproliferative disease, endothoracic

1

XVI.b Imaging: Ground-glass opacities (GGO) / shadowing

1

XVI.k Imaging: An area or areas of consolidation

1

XVI.w Imaging: Lung nodule or nodules

1

XVI.bc Imaging: Intrathoracic lymph node enlargement

1

XVII.b Opportunistic pulmonary/systemic infections

1

XVII.d Pneumocystis jiroveci pulmonary colonization

2

XVII.e Pneumocystis jiroveci pneumonia

2

XVII.h Nontuberculous pulmonary mycobacterial infection/superinfection

1

XVII.q Viral pneumonia

1

XIX.a BAL: An excess proportion of lymphocytes

3

XIX.b BAL: An excess proportion of neutrophils

1

XIX.c BAL: An excess proportion of eosinophils

1

Diagnosing DIRD

1

Drug and radiation history

2

Drug singularity - Correct identification of the drug

3

Consistent timing of exposure v. onset of symptoms

4

Clinical, imaging, BAL, pathological pattern consistent with the specific drug

5

Careful exlusion of another cause

6

Remission of symptoms with removal of drug

7

Recurrence with rechallenge (rarely advisable)

8

Causality assessment

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