Flashy lungs and sarcoidosis: not always a sign of disease activity

Main Article Content

Yousif A. Lucinian
Patrick Martineau
Francois Harel
Matthieu Pelletier-Galarneau

Keywords

Methotrexate, Pneumonitis, Sarcoidosis, PET, FDG, Fluorodeoxyglucose

Abstract

This is the case of a 68-year-old man with known cardiac sarcoidosis undergoing treatment with methotrexate who presented with new onset of dyspnea and lipothymia. FDG-PET/CT revealed pathological uptake within lung parenchyma which resolved following discontinuation of methotrexate, compatible with methotrexate-induced pneumonitis. This is the first case of methotrexate-induced pneumonitis documented by FDG-PET/CT.

Abstract 298 | PDF Downloads 229

References

1. Terasaki F, Azuma A, Anzai T, et al. JCS 2016 Guideline on diagnosis and treatment of cardiac sarcoidosis ― digest version ―. Circulation Journal. 2019;83:2329-2388.
2. Birnie DH, Sauer WH, Bogun F, et al. HRS expert consensus statement on the diagnosis and management of arrhythmias associated with cardiac sarcoidosis. Heart Rhythm. 2014;11:1305–1323.
3. Imokawa S, Colby TV, Leslie KO, Helmers RA. Methotrexate pneumonitis: review of the literature and histopathological findings in nine patients. European Respiratory Journal. 2000;15:373-381.
4. Arakawa H, Yamasaki M, Kurihara Y, Yamada H, Nakajima Y. Methotrexate-induced pulmonary injury: serial CT findings. Journal of Thoracic Imaging. 2003;18:231-236.
5. Gispen JG, Alarcón GS, Johnson JJ, Acton RT, Barger BO, Koopman WJ. Toxicity of methotrexate in rheumatoid arthritis. J Rheumatol. 1987;14:74-79.
6. Smith GJ. The histopathology of pulmonary reactions to drugs. Clin Chest Med. 1990;11:95-117.
7. Cottin V, Bendstrup E, Bonniaud P, et al. The case of methotrexate and the lung: Dr Jekyll and Mr Hyde. European Respiratory Journal. 2021;57.
8. Rossi SE, Erasmus JJ, McAdams HP, Sporn TA, Goodman PC. Pulmonary drug toxicity: radiologic and pathologic manifestations. RadioGraphics. 2000;20:1245-1259.
9. Hilliquin P, Renoux M, Perrot S, Puéchal X, Menkès CJ. Occurrence of pulmonary complications during methotrexate therapy in rheumatoid arthritis. Br J Rheumatol. 1996;35:441-445.
10. Kremer JM, Alarcón GS, Weinblatt ME, et al. Clinical, laboratory, radiographic, and histopathologic features of methotrexate-associated lung injury in patients with rheumatoid arthritis. A multicenter study with literature review. Arthritis Rheum. 1997 Oct;40(10):1829-37.
11. St Clair EW, Rice JR, Snyderman R. Pneumonitis complicating low-dose methotrexate therapy in rheumatoid arthritis. Arch Intern Med. 1985 Nov;145(11):2035-8.
12. Criado E, Sánchez M, Ramírez J, et al. Pulmonary Sarcoidosis: typical and atypical manifestations at high-resolution CT with pathologic correlation. RadioGraphics. October 2010.
13. Keijsers RGM, van den Heuvel DAF, Grutters JC. Imaging the inflammatory activity of sarcoidosis. Eur Respir J. 2013;41:743-751.