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[Methotrexate-induced pneumonitis in a woman with Crohn's disease].

HISTORY AND ADMISSION FINDINGS
A 36-year-old woman (BMI 37,2 kg m (-2)) with steroid-dependent Crohn's disease presented with stomatitis (aphthous ulcers), retrosternal pain and dry cough after 10 weeks of methotrexate treatment.


INVESTIGATIONS
Initially the C-reactive protein (CRP) was elevated, the blood gas analysis was normal, as were computed tomography (CT) and gastroscopy. Lung function tests showed restrictive partial respiratory failure. As pneumonia was suspected antibiotic treatment with ceftriaxone was started as well as topical antimycotic therapy with amphotericin B. However, within a few days the patient developed severe partial respiratory insufficiency.


DIAGNOSIS, TREATMENT AND COURSE
The CT-scan showed extensive ground-glass infiltrates, bronchoalveolar lavage revealed CD3 (+) and CD8 (+) lymphocytosis. Methotrexate-induced pneumonitis was diagnosed. Methotrexate administration was discontinued, high dose steroid application was started and ventilatory support given. These measures achieved full recovery.


CONCLUSION
Methotrexate-induced pneumonitis can be a relevant complication in Crohn's disease. Abnormal ventilation is an early sign and should lead to further investigation.