PDF(Pubmed)
Abstract：
Methotrexate (MTX), a cornerstone treatment for rheumatoid arthritis (RA), is associated with drug-induced hypersensitivity syndrome (DIHS), including rare instances of methotrexate-induced pneumonitis. We report a significant case of a 65-year-old woman with RA, treated with MTX for over two decades, who presented with fever, headache, nausea, and malaise and was later diagnosed with DIHS, manifesting as pneumonitis and hepatosplenomegaly. Despite initial suspicion of bacterial pneumonia, her condition deteriorated, leading to the consideration of DIHS. The diagnosis was confirmed through a drug lymphocyte stimulation test (DLST), and she responded well to prednisolone. This case underlines the complexity of long-term MTX therapy, emphasizing the need for vigilance towards DIHS even after years of treatment. The findings prompt a reconsideration of ongoing treatments for RA, particularly in settings where long-term MTX use is prevalent. Early intervention and diagnostic tests like the DLST are crucial for preventing severe outcomes. This case adds to the growing evidence of MTX\'s potential for causing DIHS even in long-term usage. It stresses the importance of balancing therapeutic benefits with the risks of significant adverse reactions in stable RA patients.
摘要：
甲氨蝶呤(MTX),类风湿关节炎（RA）的基础治疗，与药物诱导的超敏反应综合征（DIHS）有关，包括罕见的甲氨蝶呤诱导的肺炎。我们报告了一个65岁的RA患者的重要病例，用MTX治疗了二十多年，发烧的人，头痛,恶心,和不适，后来被诊断出患有DIHS，表现为肺炎和肝脾肿大。尽管最初怀疑是细菌性肺炎,她的病情恶化了,导致DIHS的考虑。通过药物淋巴细胞刺激试验（DLST）证实了诊断，她对泼尼松龙反应良好。该病例强调了长期MTX治疗的复杂性，强调即使经过多年的治疗，也需要对DIHS保持警惕。这些发现促使人们重新考虑正在进行的RA治疗，特别是在长期使用MTX的环境中。早期干预和DLST等诊断测试对于预防严重的结果至关重要。这个案例增加了越来越多的证据表明，即使在长期使用中，MTX也有可能导致DIHS。它强调了在稳定的RA患者中平衡治疗益处与重大不良反应风险的重要性。
