Información del artículo
Resumen
La neumonitis por metotrexato es una complicación aguda y grave que se caracteriza por la instauración de tos seca, disnea y fiebre, con aparición de un patrón radiológico de infiltrado intersticial que obliga a la retirada del fármaco. Su patogenia se atribuye a un mecanismo de hipersensibilidad yse recomienda no reintroducir el metotrexato tras su resolución. Los factores de riesgo reconocidos son la edad avanzada, la diabetes mellitus, la hipoalbuminemia y las manifestaciones extraarticulares de la artritis reumatoide, especialmente la pulmonar. El tratamiento con glucocorticoides a dosis altas y las medidas de soporte respiratorio favorecen la resolución clínica completa, aunque la mortalidadalcanza el 10-18% de las series.
Palabras clave:
Metotrexato
Neumonitis
Toxicidad pulmonar
Abstract
Pneumonitis is a serious and unpredictable side-effect of methotrexate treatment, appearing acutely or subacutely with cough, fever, dyspnoea and radiological evidence of pulmonary interstitial or alveolar infiltrates. Methotrexate pneumonitis is an idiosyncratic immume reaction and identified risk factors include old age, diabetes, hypoalbuminemia and extraarticular manifestations, particularly rheumatoid lung. Management of this complication include metotrexate withdrawal, high corticosteroid doses and respiratory support, but mortality has been reported in 10-18% of patients.
Key words:
Methotrexate
Pneumonitis
Lung toxicity
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