CTICasesMethotrexate-induced Lung Toxicity (Organizing Pneumonia)
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Imaging findings
A patient on methotrexate for rheumatoid arthritis presented with acute dyspnea and asymmetric patchy lung consolidation and ground-glass opacities on CT. Emphysematous changes were also present. Perilobular bands of consolidation suggested organizing pneumonia. Following discontinuation of methotrexate and initiation of steroids, serial scans demonstrated slow but significant improvement, progressing to almost full recovery.
Key takeaways
Methotrexate-induced lung toxicity is a recognized complication, often presenting as organizing pneumonia or acute interstitial pneumonia. Clinical suspicion, especially with a history of methotrexate use and new lung opacities, is crucial. Discontinuation of the drug and steroid therapy typically lead to resolution.
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