SHM Converge Scientific Abstract ePoster Gallery-Methotrexate Induced Lung Injury

Pdf Summary

An 88-year-old woman with autoimmune iritis on chronic methotrexate presented after a fall and was found to be hypoxic with an oxygen saturation of 80% on room air. Initial evaluation showed markedly elevated D-dimer, bilateral diffuse interstitial changes on chest x-ray, pulmonary hypertension on echocardiogram, and no evidence of COVID-19, pulmonary embolism, or bacterial infection. She was initially treated for possible pulmonary edema, but her respiratory status worsened over the next three days, requiring high-flow oxygen. Chest CT revealed mid-to-lower lung bronchiectasis with ground-glass, reticular, and consolidative opacities, raising concern for progressive nonspecific interstitial pneumonitis (NSIP) related to methotrexate toxicity.  <br /><br />Methotrexate and diuretics were stopped, and autoimmune and infectious workup was largely negative except for HLA-B27 positivity. Given the severity of her hypoxemia and worsening imaging, she was treated with methylprednisolone 60 mg, which led to significant clinical and radiographic improvement. She was discharged on low-flow oxygen with a steroid taper.  <br /><br />This case highlights methotrexate-induced lung injury, a rare but well-recognized adverse effect that can present with nonspecific respiratory symptoms and variable CT findings, including NSIP patterns. Diagnosis requires careful exclusion of infection, heart failure, and autoimmune lung disease. The main treatment is prompt discontinuation of methotrexate; systemic steroids may be needed in severe cases.

Asset Subtitle

Kajal Patel

Meta Tag

Author List Christopher Chan, Kajal Patel

Category Clinical Vignettes

Concept Methotrexate

Concept Drug-Induced Lung Injury

Concept Methotrexate Discontinuation

Concept Interstitial Pneumonitis

Concept Early Recognition

Distinguished Non-Finalist

Presenter Organization Wellstar Kennestone Regional Hospital

Presenting Author Kajal Patel

Track Adult

Keywords

methotrexate-induced lung injury

nonspecific interstitial pneumonitis

hypoxemia

ground-glass opacities

bronchiectasis

interstitial lung disease

systemic corticosteroids

autoimmune iritis

HLA-B27 positivity

pulmonary hypertension

Methotrexate

Drug-Induced Lung Injury

Methotrexate Discontinuation

Interstitial Pneumonitis

Early Recognition