Methotrexate Therapy and Pulmonary Disease

Eight instances of a rapidly progressive pulmonary illness manifested by cough, dyspenea, fever, and cyanosis have been seen in patients on maintenance methotrexate therapy for leukemia. The roentgenographic, findings include diffuse bilateral pulmonary infiltrates which typically are predominantly interstitial early in the course of the disease with the subsequent development of confluent alveolar densities. Despite the severity of the clinical and radiographic changes, the disease is usually self-limited. The syndrome simulates and must be differentiated from acute disseminated progressive infectious processes, particularly Pneumocystis carinii pneumonia.