Methotrexate Case Study
A patient on methotrexate presenting with chronic cough and dyspnea will typically prompt consideration of methotrexate toxicity, however occult lung infections such as pulmonary toxoplasmosis (with a 40% toxicity in the immunosuppressed) can present similarly.
A 55-year-old female with a background of rheumatoid arthritis on methotrexate and steroids presented with shortness of breath and non-productive cough of 2 months. She denied hemoptysis, fever, night sweats, weight loss or recent travels. Of note, patient had a cat and ingested partially cooked hamburger. Vitals signs were within normal limits and physical examination including lung examination was unremarkable. ESR was mildly elevated – 35mm/hr otherwise CBC, electrolyte, HIV and
A 55-year-old female with a background of rheumatoid arthritis on methotrexate and steroids presented with shortness of breath and non-productive cough of 2 months. She denied hemoptysis, fever, night sweats, weight loss or recent travels. Of note, patient had a cat and ingested partially cooked hamburger. Vitals signs were within normal limits and physical examination including lung examination was unremarkable. ESR was mildly elevated – 35mm/hr otherwise CBC, electrolyte, HIV and