RESUMO
Methotrexate may rarely provoke serositis, even with low doses and after just a few weeks of therapy. We report here a rare case of pleuropericarditis due to methotrexate. The effusion resolved after the withdrawal of the drug and the beginning of anti-inflammatory therapy; there was no relapse during a 10-month follow-up.
Assuntos
Fármacos Dermatológicos/efeitos adversos , Metotrexato/efeitos adversos , Pericardite/induzido quimicamente , Pleurisia/induzido quimicamente , Psoríase/tratamento farmacológico , Anti-Inflamatórios/uso terapêutico , Aspirina/uso terapêutico , Doença Crônica , Colchicina/uso terapêutico , Fármacos Dermatológicos/uso terapêutico , Quimioterapia Combinada , Humanos , Masculino , Metotrexato/uso terapêutico , Pessoa de Meia-Idade , Pericardite/tratamento farmacológico , Pericardite/microbiologia , Pleurisia/tratamento farmacológico , Pleurisia/microbiologia , Psoríase/patologiaRESUMO
PURPOSE: To assess potential new prognostic factors and to validate the AIDS Clinical Trials Group (ACTG) for AIDS-related Kaposi's sarcoma (AIDS-KS) staging system in the highly active antiretroviral therapy (HAART) era. PATIENTS AND METHODS: We collected epidemiologic, clinical, staging, and survival data from 211 patients with AIDS-KS enrolled in two prospective Italian human immunodeficiency virus (HIV) cohort studies. We included in the analysis all patients with the diagnosis of KS made from January 1996, the time at which HAART became available in Italy. RESULTS: In the univariate analysis, survival was not influenced by sex, age, level of HIV viremia at KS diagnosis, HAART at KS diagnosis (HAART-naïve v HAART-experienced), or type of HAART combination. Regarding ACTG classification, the 3-year survival rate was 85% for T0 patients and 69% for T1 patients (P =.007), 83% for S0 patients and 63% for S1 patients (P =.003), and 83% for I0 patients and 71% for I1 patients (P =.06). In the multivariate analysis, only the combination of poor tumor stage (T1) and poor systemic disease (S1) risk identified patients with unfavorable prognosis. The 3-year survival rate of patients with T1S1 was 53%, which was significantly lower compared with the 3-year survival rates of patients with T0S0, T1S0, and T0S1, which were 88%, 80%, and 81%, respectively (P =.0001). CONCLUSION: In the era of HAART, a refinement of the original ACTG staging system is needed. CD4 level does not seem to provide prognostic information. Two different risk categories are identified: a good risk (T0S0, T1S0, T0S1) and a poor risk (T1S1).
