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].
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