The most common pulmonary disorder induced by methotrexate is a gradually developing interstitial pneumonitis. The associated clinical manifestations include slowly progressive dyspnea and nonproductive cough, with extensive radiographic changes. One case has been reported following intrathecal methotrexate administration; the remainder occurred after either intravenous or oral therapy. We report two cases of rapidly developing respiratory distress following the administration of methotrexate into the cerebrospinal fluid. The clinical courses, radiologic findings, and, in one patient, the pathologic nature, are consistent with noncardiogenic pulmonary edema.
We report on a case of 46,XY/46,XY,r(19) mosaicism. The patient shows minimal clinical abnormality and the terminal deletions prerequisite for the ring formation are not microscopically discernible. The origin of the mosaicism is discussed. Firstly, the mosaicism may represent chimerism with a prezygotic origin of the ring chromosome; secondly, the ring chromosome could have arisen postzygotically; and thirdly, the ring could have been of a prezygotic origin with the apparently normal cells actually containing reopened rings. The consequences of these hypothesis on genetic counselling are discussed.
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