Methotrexate pulmonary toxicity

Drug-induced pulmonary disease is a well-recognized complication of methotrexate (MTX) treatment of rheumatic diseases. Characteristic symptoms are shortness of breath, nonproductive cough, fatigue, and fever. If a MTX-induced pulmonary reaction is suspected and abnormalities are noted on lung examination, a chest radiograph should be performed. in the presence of an abnormal chest radiograph, MTX should be discontinued, supportive measures instituted, and the diagnosis of the patient's pulmonary complaints investigated by specifically looking for features of the underlying rheumatic process, infection, and other medical condition. Patients with severe pulmonary compromise should be hospitalized and given supplemental oxygen, and high-dose corticosteroids should be instituted. All patients receiving MTX should be educated concerning its potential life-threatening drug toxicity and instructed to contact their physician immediately if significant pulmonary symptoms develop.