A 45-year-old female with a 4-week history of psoriatic arthritis developed cough, fever, and progressive shortness of breath 2 weeks following initiation of methotrexate therapy. High resolution CT of chest revealed bilateral basal interstitial involvement and diffuse ground glass opacities. Patient, though, died despite immediate discontinuation of methotrexate and initiation of treatment with IV methylprednisolone and cyclophosphamide. Post-mortem examination showed diffuse interstitial pulmonary fibrosis. Methotrexate-induced pulmonary toxicity is a serious event, unpredictable, and unusual, especially in patients with psoriatic arthritis, and although reversible, it may be fatal.
155 pacientes tenían exposición al humo de los cuales 103 (5,6%) reunían los criterios de inclusión. 97% de los casos eran mujeres. Los cambios histológicos principales fueron: enfermedad vascular hipertensiva (39%), tromboembolismo pulmonar de vasos de pequeño y mediano calibre (38%) y antracosis peribronquial, perivascular e intersticial. En todos los parámetros histológicos se apreció mayor compromiso pulmonar con el mayor tiempo de exposición al humo de leña. A pesar de sus características peculiares no es posible clasificarla como una entidad nosológica, estando en la categotía de las neumoconiosis. En conclusión, es una condición clínico-patológica frecuente en nuestro medio, especialmente entre mujeres que han estado expuestas por muchos años al humo de leña; entre los cambios histológicos no patognomónicos, se encuentra el depósito de pigmento de antracosis, la enfermedad vascular hipertensiva, la fibrosis pulmonar y los cambios de bronquitis crónica.Pneumopathy due to inhaling firewood smoke. Autopsy findings from the San Juan de Dios Hospital 1,839 autopsy protocols from the San Juan de Dios Hospitalwere revised, 155 patients had been exposed to smoke, of whom 103 (5.6%) met the inclusion criteria. 97% were women. The principal histological changes were: hypertensive vascular disease (39%), pulmonary thrombo-embolism of the small and rnedium calibre vessels (38%) and peribronchial, perivascular and interstitial anthracosis. In al1 histological parameters, greater pulmonary compromise was seen in relation to greater exposure to firewood smoke. In spite of these peculiar characteristics, it is not possible to classify it as a nosological entity, being in the pneumoconiosis category. In conclusion it is a frequently occuring clinical-pathological condition in our environment, especially amongst women who have been exposed to firewood smoke for many years. Amongst the non-pathognomic histological changes, anthracosis pigment deposits, hypertensive vascular disease, pulmonary fibrosis and chronic bronchitis changes were found.La neumopatía por humo de leña es una enferintensa y prolongada al humo de leña en el medad pulmonar asociada con una exposición interior de la casa. Se han observado por varios
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