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Query: UMLS:C0032285 (pneumonia)
 54,520 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Despite cytolytic induction therapy and triple-drug immunosuppression, acute allograft rejection continues to cause important morbidity and occasional death after heart transplantation. Between November 1, 1988, and May 1, 1990, 24 patients received methotrexate pulse therapy for recurrent or persistent acute rejection despite methylprednisolone, OKT3, or antithymocyte globulin therapy. Methotrexate was administered as a daily oral dose of 2.5 to 15 mg on 1 day/week over 3 weeks (longer in 15 patients because of either severe leukopenia with temporary interruption of therapy or recurrent rejection during methotrexate therapy) with reduction or discontinuation of azathioprine. Rejection incidence was reduced from 1.1 episodes/patient month before methotrexate therapy to 0.2 episodes/patient month after completion of therapy (p = 0.0001). Two patients died within 3 months after treatment, one of cytomegalovirus pneumonia and one of lymphoma. Mean white blood count (WBC) fell from 6900 per ml before methotrexate therapy to 3700 during the first month of methotrexate therapy (p = 0.0005). The lowest WBC typically occurred about 3 weeks after starting methotrexate therapy, and a transient WBC of less than 1000/ml developed in seven patients. By multivariable analysis, the WBC 1 month after starting methotrexate therapy was significantly related to greater bone marrow suppression (lower WBC), immediately before methotrexate therapy, greater overall immunosuppression (more rejection episodes) during the 3 months before methotrexate therapy, and a higher total dose of methotrexate. The following conclusions can be drawn: (1) Methotrexate is a useful adjunct in the treatment of recurrent or persistent rejection.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Methotrexate pulse therapy in the treatment of recurrent acute heart rejection. 145 34

Five patients with documented recurrences of glioblastoma multiforme were given continuous infusions of methotrexate delivered intratumorally using implantable catheters and subcutaneous refillable pumps. A continuous infusion of methotrexate (1 mg/d) was begun with concomitant oral administration of folinic acid. The methotrexate dose was increased every 2 weeks to 3, 10, 30, and, ultimately, 75 mg/d in two patients. Samples of serum and ventricular cerebrospinal fluid (CSF) were obtained to determine the levels of methotrexate and total bioactive folates, and brain tissue was obtained from two patients for determination of methotrexate concentration. The patients survived from 7 to 49 weeks after the implantation of the infusion device. Neither the clinical examination nor sequential radiological studies gave clear evidence of reduction in tumor size. Pneumonia developed in one patient, and mild hepatitis and increased seizure frequency in another. Methotrexate was stable in the delivery system over 12 days, and ventricular CSF reached steady-state levels by 5 days. Steady-state ventricular CSF levels of methotrexate were higher than serum levels in some patients, while the reverse was true in others. Levels of total bioactive folates in the CSF did not increase above the normal range. Methotrexate concentrations were highest at the center of the tumor, but measurable amounts of methotrexate were detectable in all areas of the brain. At autopsy in four patients, variable liquefactive necrosis of the brain tumors was seen, and viable tumor was found at the periphery of the tumor bed. These preliminary results suggest that it is technically feasible to infuse methotrexate into brain tumor cavities, and show that little central nervous system or systemic toxicity was encountered in five patients. Better delineation of the safety and efficacy of this therapeutic approach will require further clinical trials.
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PMID:Continuous intratumoral infusion of methotrexate for recurrent glioblastoma: a pilot study. 165 12

Methotrexate (MTX) is used as sequential treatment of rheumatoid arthritis in doses ranging from 5 to 20 mg per week, but its effectiveness is impaired by undesirable and sometimes severe side-effects, notably on the lungs. We report three cases of lung disease in patients with rheumatoid arthritis under MTX therapy. Two patients had a lung infection caused by Escherichia coli and Pneumocystis carinii respectively and the third patient was a case of fatal pneumonia imputed to MTX. The signs and symptoms of these acute infectious or iatrogenic lung diseases are not specific. Bronchial endoscopy with bronchoalveolar lavage usually leads to a diagnostic of opportunistic infection, but it may also show an isolated excess, in both number and percentage, of alveolar leucocytes, pointing to a drug-induced pneumopathy. Acute respiratory failure due to MTX-induced pneumonia is not uncommon. It rapidly regresses either spontaneously or under corticosteroid therapy, but a number of deaths, as in our last patient, have been reported. The occurrence of these lung diseases is unrelated to the total dose of MTX. Reintroducing MTX does not mean that the condition will necessarily recur, but this can only be done in the absence of any other possible treatment.
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PMID:[Lung diseases and treatment with methotrexate in rheumatoid arthritis]. 177 74

Methotrexate may be effective in patients with rheumatoid arthritis refractory to other treatments (gold salts, d-penicillamine and antimalarial drugs). Success rates from 39 to 88% have been reported. The mechanism of action is unknown, but is supposedly related to anti-inflammatory and immunosuppressive effects. Frequent side effects are observed on prolonged treatment. Most of these are mild and disappear with dose reduction. An exception is pneumonitis, a hypersensitivity reaction that may appear early and at low doses. Hepatotoxic effects are milder than those observed in patients with psoriasis. Intraarticular administration is not effective. No carcinogenic effects have been observed in humans. The drug should be administered with caution in fertile males and females due to possible teratogenic effects. New studies involving larger number of patients may help establish a significant role for methotrexate in the treatment of rheumatoid arthritis.
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PMID:[Methotrexate in rheumatoid arthritis]. 184 76

This retrospective study involved 60 patients (7 men, 53 women) with rheumatoid arthritis (RA) and given methotrexate between 1985 and 1990. The mean time that RA had been present was 12 years and more than half of the patients had received more than 3 types of general treatment in the past. The mean total duration of MTX was 17.3 months, with a total dose of 790 mg. The efficacy of MTX was confirmed by a significant improvement in clinical and laboratory parameters. Treatment was withdrawn permanently in 21 cases (35% of patients). Adverse reactions, responsible for two thirds of treatment withdrawals (14/21) occurred in most instances during the first year of treatment. Hepatic toxicity was commonest. Two cases of aplasia were reported as well as 3 cases of pneumonitis, one fatal. These involved two cases of secondary infection and one of pneumonitis directly imputable to MTX. Withdrawals for inefficacy were rare, occurring in less than 10 p. cent of patients. Treatment continuation rates were 77 p. cent at 1 year, 66 p. cent at 18 months, 55 p. cent at 2 years, 42 p. cent at 3 years and 32 p. cent at 4 years. MTX is effective treatment for RA but is not free of adverse reactions, sometimes potentially fatal. Prolonged monitoring is necessary because of the sometimes delayed onset of adverse reactions.
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PMID:[Treatment of rheumatoid polyarthritis with methotrexate]. 189 82

Eighteen patients with leukemia have received HLA-identical allogeneic bone marrow transplantation (BMT) at our hospital since 1981. Fifteen of these patients have been living without relapse. for prophylaxis of GVHD, MTX was used in 8 patients, and cyclosporine (CSP) together with MTX in 6 patients, 3 received multiple agents at much smaller dosage, including monoclonal antibody. All patients received intravenous placental gamma-globulin, and 16 received garlic extract. Three patients died. One, who neither received MTX, nor CSP died of hyperacute GVHD, one who did not receive garlic extract died of GMV pneumonia, and the third one died of tuberculosis 18 months after BMT.
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PMID:Allogeneic bone marrow transplantation for the treatment of leukemia. 211 28

Methotrexate, an antifolate cytotoxic drug, is used in anticancer chemotherapy as well as an immuno suppressive in rheumatoid arthritis. It is responsible for numerous secondary effects, amongst which is a characteristic acute pneumonia known since 1969. This pneumonitis has been described in detail, up to the present time in 78 cases gathered in this review. The prevalence of this complication is estimated at around 7%. This pneumonia may occur whatever the age, indication for which methotrexate is prescribed, the route of administration of the product (including the intra-thecal route) and the dose. It includes dyspnoea, fever, (sometimes quite marked) and frequently an acute reversible respiratory failure. Radiologically the opacities are usually diffuse interstitial and symmetrical with a basal predominance with sometimes some confluence and occasionally a pleural reaction. In a small number of cases a transient mediastinal adenopathy has been described. Respiratory function tests show a rapidly developing restrictive syndrome accompanied by hypoxia and hypocapnia. Broncho-alveolar lavage is characterised by hypercellularity with a frank and apparently transitory lymphocytosis. Histologically the most frequent lesion sighted is an extensive acute granulomatous reaction with or without oedema. Most often the outcome is favourable (75% of cases). However 6 deaths due to respiratory failure have been reported. Even though there has not been any formal test, steroid therapy in high dosage seems to accelerate recovery. Progress to an irreversible pulmonary fibrosis is possible but rare. The mechanism of this drug related acute pneumonia is not known but would seem to resemble that of other granulomatosis. Besides this rapidly progressive pneumonitis, methotrexate is responsible for a very small number of cases of severe pulmonary oedema and of acute painful pleurisies.
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PMID:[Pneumopathy caused by methotrexate]. 225 35

Pneumonitis has been reported to be a rare complication of low-dose MTX treatment. This paper describes a 62-year-old male patient in whom clinically successful low-dose treatment was applied. After six months of treatment, a gradually progressive pulmonary symptomatology developed and abruptly deteriorated. Radiological examination revealed interstitial and intra-alveolar densifications; functional analysis revealed partial respiratory failure. The histological finding of interstitial lymphocytic infiltration with giant cells and a chronic intra-alveolar pneumonia, with bacteriological detection of E. coli and Proteus vulg. in the BAL fluid, confirmed the suspected diagnosis of primary MTX-induced pneumonitis with secondary bacterial superinfection. In view of the fact that the literature does not seem to contain unequivocal definition, it is urgently recommended that unequivocal criteria be established.
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PMID:[Pneumonitis as a complication of low-dose methotrexate therapy in chronic polyarthritis]. 236 74

Methotrexate (MTX) is used widely for the treatment of a variety of tumors as well as for non-neoplastic conditions. Its association with pneumonitis is well established, but the mechanism of lung injury is unknown. To clarify this issue, we performed bronchoalveolar lavage (BAL) in six patients with MTX pneumonitis and in three control groups. In those with drug-induced pneumonitis, there was a significant increase in the total number of lavage cells recovered as well as in the percentage and absolute number of lymphocytes compared with those in the other groups. Patients receiving the drug without evidence for pulmonary toxicity had lavage findings that were not different from those in the other control groups. The ratio of BAL phenotypic helper/suppressor T-cells was studied in three patients with MTX toxicity and was found to be increased compared with that in normal healthy control subjects. Our findings show that MTX pneumonitis is characterized by a lymphocytic alveolitis with a predominance of phenotypic helper T-cells and a relative deficiency in the percentage of suppressor T-cells. The presence of increased lavage lymphocytes suggests that an immunologically mediated injury rather than a direct toxic effect of this drug may be a significant pathophysiologic mechanism in this disorder.
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PMID:Methotrexate pneumonitis. Bronchoalveolar lavage findings suggest an immunologic disorder. 252 38

Methotrexate is used to treat a growing number of malignancies, severe rheumatoid arthritis, and refractory psoriatic arthritis. Pneumonitis induced by the drug occurs in a small percentage of patients and is usually associated with fever, cough, dyspnea, and restrictive pulmonary disease. Severe reactions may progress to respiratory failure. Early recognition of the toxicity is important, and discontinuation of the drug and therapy with corticosteroids usually lead to dramatic improvement.
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PMID:Methotrexate pneumonitis: a case report and summary of the literature. 267 17


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