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Rheumatology 1999; 38: 908
© 1999 British Society for Rheumatology

Letters to the Editor

Angio-neurotic oedema associated with methotrexate treatment in rheumatoid arthritis

A. M. Freeman and B. Dasgupta

Department of Rheumatology, Southend Hospital, Prittlewell Chase, Westcliff-on-Sea, Essex SS0 0RY, UK

SIR, We would like to report a case of angio-neurotic oedema associated with methotrexate in a 53-yr-old female with a 17 yr history of rheumatoid arthritis. Methotrexate was started in 1995 and was stopped 2 months later owing to abnormal liver function tests.

In 1996, as a consequence of a rheumatoid arthritis flare, she was restarted on methotrexate, initially 7.5 mg weekly and gradually increased to 12.5 mg.

She then developed `pharyngeal oedema' and had to be admitted on two separate occasions, with a swollen tongue and a puffy face. Cholinesterase estimations were normal. Two months later, she had a typical angio-neurotic oedema episode, despite treatment with antihistamines and Danazol.

Last year, methotrexate was stopped, since when there have been no further attacks.

A literature search (Medline) revealed only two other associations: one following intrathecal administration in a case of acute lymphatic leukaemia [1], the second following i.v. administration in a case of osteosarcoma [2].

References

  1. Lascari AD, Strano AJ, Johnson WW, Collins JG. Methotrexate-induced sudden fatal pulmonary reaction. Cancer 1977;40:1393–7.[Medline]
  2.  Alkins SA, Byrd JC, Morgan SK, Ward FT, Weiss RB. Anaphylactoid reactions to methotrexate. Cancer 1996;77:2123–6.[Medline]
Accepted 24 March 1999


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