Mycobacterium intracellulare Pulmonary Disease with Endobronchial Caseation in a Patient Treated with Methotrexate / 결핵및호흡기질환

Methotrexate (MTX) has been established as a standard disease-modifying anti-rheumatic drug. If adequate disease control is achieved for a reasonable period of time, tapering the MTX dosage is recommended because the chronic use of MTX can result in opportunistic infection. We present here a case of a woman with rheumatoid arthritis taking MTX, and the woman developed actively caseating endobronchial Mycobacterium intracellulare disease with pulmonary infiltrations. After discontinuing the MTX, the patient was able to tolerate 18 months of antimycobacterial treatment without flare ups of rheumatoid arthritis, and she completely recovered from nontuberculous mycobacterial respiratory disease.

Drug-induced Skin Hyperpigmentation after Usual Dosage of Bismuth-Containing Compound Medication in a Kidney Transplant Patient / 대한신장학회지

A 59-year-old male presented with multiple hyperpigmented skin with hyperkeratotic scaly patches on hands, feet and face. Bismuth containing compound had been prescribed two months before then due to epigastric pain, an adverse effect of steroid pulse therapy for acute rejection of transplanted kidney. Laboratory findings showed acute kidney injury and elevated liver enzyme. He stopped taking bismuth containing compound and all symptoms were gone after two months. Although there is no report on interaction between bismuth and immunosuppressant, it requires precaution to prescribe bismuth containing compounds in transplanted patients with acute kidney injury.