To the Editor:—
We have seen two cases we believe to be the pulmonary disease complicating intermittent therapy with methotrexate as described by Clarysse et al in the Sept 22, 1969, issue of The Journal.1 In both these patients, we have treated this complication with prednisone which resulted in prompt recovery.
Report of Cases.—Case 1.—
The diagnosis of acute lymphoblastic leukemia was made in a 13-year-old girl on Dec 27, 1967. A complete remission was induced within four weeks with orally administered prednisone, 40 mg/sq m daily, and vincristine, 2 mg/sq m weekly, was administered intravenously. This was followed by maintenance therapy with methotrexate, given orally twice weekly and adjusted to a maximally tolerated dose (25 mg twice weekly). On July 10, 1968, approximately 150 days after initiation of methotrexate therapy, the patient was rehospitalized with headaches, cough, high fever, severe dyspnea, tachypnea, and cyanosis. There were