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Methotrexate-Induced Pneumonitis: Diagnostic Value of Bronchoalveolar Lavage Cell Data

Georges M. Akoun, MD; Charles M. Mayaud, MD; Jean-L. Touboul, MD; Michel Denis, MD
Arch Intern Med. 1986;146(4):804-805. doi:10.1001/archinte.1986.00360160260038.
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To the Editor.  —We have observed five cases of methotrexate-induced pneumonitis that were comparable with the three cases reported in the Archives by St Clair et al.1 We would like to draw attention to the diagnostic value of bronchoalveolar lavage (BAL) data in such settings.In the cases reported by St Clair et al, diagnosis of methotrexate-induced pneumonitis were ascertained by clinical and radiologic data, blood-gas levels, and evolution; in addition, specimens from lung biopsies showed significant granulomas and type 2 alveolar cell hyperplasia in one case, and, in the others, some fibrosis and edema associated with type 2 alveolar cell hyperplasia. However, all tests for bacteria, mycobacteria, fungi, and Pneumocystis carinii showed negative results.Our five patients were nonsmoking women, with an average age of 34 years (range, 18-61 years). Choriocarcinomas developed in three patients, a myelogenic acute leukemia developed in one patient, and breast cancer developed in

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