Case ReportAccelerated Pulmonary Nodulosis and Sterile Pleural Effusion in a Patient With Psoriatic Arthropathy During Methotrexate Therapy A Case ReportBalbir-Gurman, Alexandra MD*; Guralnik, Ludmila MD†‡; Best, Lael-Anson MS‡§; Vlodavsky, Eugene MD, PhD‡¶; Yigla, Mordehai MD‡∥; Menahem Nahir, Abraham MD, PhD‡; Braun-Moscovici, Yolanda MD*‡Author Information From the *B. Shine Department of Rheumatology, Rambam Health Care Campus; †Department of Clinical Imaging, Rambam Health Care Campus; ‡B. Rappaport Faculty of Medicine, Technion-Israel Institute of Technology; §Department of Thoracic Surgery, Rambam Health Care Campus; ¶Institute of Pathology, Rambam Health Care Campus; and ∥Pulmonary Division, Rambam Health Care Campus, Haifa, Israel. Correspondence: Dr. Alexandra Balbir-Gurman, B. Shine Department of Rheumatology, Rambam Health Care Campus, POB 9602, Haifa 31096, Israel. E-mail: [email protected]. JCR: Journal of Clinical Rheumatology: January 2009 - Volume 15 - Issue 1 - p 29-30 doi: 10.1097/RHU.0b013e31817de10b Buy Metrics AbstractIn Brief Pulmonary nodulosis and sterile pleural exudates are well-known extra-articular manifestations in rheumatoid arthritis patients with a positive rheumatoid factor. In some patients, treatment with methotrexate has been postulated as the trigger of these complications. We report a patient with psoriatic arthropathy, negative RF, negative anticyclic citrulinated peptide antibodies but positive antibodies to cardiolipin who developed massive sterile pleural empyema and multiple cavitary pulmonary nodules during methotrexate treatment. We suggest that awareness of methotrexate-induced lung and pleural complications should be extended to other than rheumatoid arthritis diseases, not necessarily accompanied by rheumatoid factor or anticyclic citrulinated peptide antibodies. This patient with psoriatic arthritis, negative RF and negative anti-CCP developed pulmonary rheumatoid nodules while on treatment with methotrexate. © 2009 Lippincott Williams & Wilkins, Inc.