Methotrexate lung disease

Methotrexate lung disease is specific aetiological type of drug induced lung disease. It can occur due to administration of methorexate which is an antimetabolite, which is given for various reasons but commonly to treat rheumatoid arthritis. It is also given alone or in combination with other chemotherapeutic agents to treat a wide variety of malignancies including lung, breast, and head and neck epidermoid cancers, non-metastatic osteosarcoma, and advanced-stage non-Hodgkin lymphoma.

It is thought to occur in ~5% (range 0.3-10%) of patients treated with methotrexate 1-2.

The typical clinical symptoms include progressive shortness of breath and cough, often associated with fever 6. Hypoxaemia and tachypnoea are always present and crackles are frequently audible. Symptoms typically manifest within months of starting therapy). There appear to be is no correlation between the development of drug toxicity and the duration of therapy or total cumulative dose) 1.

There can be several manifestation of methotrexate related lung changes


CT features can be variable and included diffuse parenchymal opacification, reticular opacities, and centrilobular nodules 2. An NSIP pattern is considered the most common manifestation of methotrexate-induced lung disease 1.

Overall prognosis would depend on the exact form of disease. In general the prognosis is considered good, with most patients improving despite continuation of therapy. Patients with lung fibrosis at presentation may have worse prognosis 2.

Share article

Article Information

rID: 17510
System: Chest
Section: Pathology
Tag: cases
Synonyms or Alternate Spellings:
  • Methotrexate induced lung disease
  • Methotrexate related lung disease
  • Methotrexate induced pulmonary drug toxicity
  • Methotraxate pneumonitis

Support Radiopaedia and see fewer ads

Updating… Please wait.

Alert accept

Error Unable to process the form. Check for errors and try again.

Alert accept Thank you for updating your details.