P134 Navigating diagnostic uncertainty: a case of systemic lupus erythematosus-associated organising pneumonia in a patient on methotrexate
Abstract
Systemic lupus erythematosus (SLE) has been linked to an array of pulmonary complications, both due to the disease itself, but also secondary to pharmacological management options used to control the other manifestations of the disease. The authors present a case of organising pneumonia (OP) secondary to SLE in a patient on methotrexate (MTX), initially mistaken for MTX-induced chemical pneumonitis. The focus of the case is the diagnostic algorithm used in the work-up of the manifestation, as well as the fact that the OP remitted with mycophenolate mofetil, but not belimumab.
A woman in her 30s is followed up at our local rheumatology clinic for SLE and antiphospholipid syndrome. Her lupus had presented with arthritis and discoid rashes at the age of 16, and her antiphospholipid syndrome had presented with a deep vein thrombosis of her calf at the age of 11. The patient had been in deep remission on hydroxychloroquine (HCQ) when she developed a relapse of arthritis in the context of work-related stress in mid-2023. Due to an elevated double stranded DNA titre, an elevated erythrocyte sedimentation rate and the presence of synovitis on ultrasonography, it was decided to introduce MTX at a dose of 20 mg weekly. The arthritis improved and her disease activity index normalised. However, within 5 weeks of commencing MTX, the patient experienced dyspnoea and a cough. She was found to be hypoxic, and was referred for cross-sectional imaging of her chest. This revealed the presence…
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