Methotrexate-induced Pleuropericarditis and Eosinophilic Pleural Effusion

Abstract

A 41-year-old man developed widespread skin rash involving his knees, elbows, and gluteal region. He received methotrexate for approximately 1 month and later developed dyspnea and a left-sided eosinophilic pleural effusion. He was transiently placed on oral steroids. Subsequent skin biopsy showed psoriatric arthritis. Methotrexate was restarted and 8 weeks into the treatment, he developed dyspnea, a hemorrhagic pericardial effusion, and a right-sided eosinophilic pleural effusion. Methotrexate was discontinued, but patient developed dyspnea with a recurrent right eosinophilic pleural effusion, 2 weeks later. Pleural biopsies were obtained through medical pleuroscopy that revealed mild chronic inflammation with prominent eosinophils and no evidence for malignancy. Oral steroids were restarted with significant improvement in his symptoms.

Pericarditis Induced by Methotrexate: A Case Report and Literature Review

“…cases were male. The primary diagnoses associated with these cases were rheumatoid arthritis [ 1 , 16 ], molar pregnancies [ 2 , 17 ], psoriatic arthritis [ 13 , 18 ], cutaneous psoriasis [ 19 ], and T-cell lymphoma [ 20 ]. The diagnosis of pericardial effusion was typically made using clinical and imaging techniques, such as echocardiography, chest X-ray, computerized thoracic tomography, and electrocardiography.…”

“…It is important to note that, while these cases suggest an association between the use of MTX and pericardial or pleural effusion, further research is needed to establish a causal relationship. Close monitoring of patients using MTX for potential adverse events such as pericardial effusion is crucial, and any symptoms should be reported to their healthcare provider [1,13,[16][17][18][19][20].…”

Eosinophilic Pleural Effusion Induced by Paliperidone Palmitate: Case Report and Literature Review

“…However, case reports have shown recurrences of EPE when the offending drug is reintroduced. 17,19 These recurrences are again treated by drug discontinuation, and the addition of corticosteroids is sometimes necessary. 17 The situation should therefore be assessed on a case-by-case basis.…”

Pirfenidone-induced Eosinophilic Pleurisy

“…Only 2 case reports have described drug-induced EPE in which medical thoracoscopy was performed. The causative agents in those cases were methotrexate ( 7 ) and oranzapine ( 8 ). In those 2 cases and our own pirfenidone-induced case, drug-induced EPE was reported to present with pleural thickening involving eosinophilic inflammation without other specific findings.…”