Conversation: The conversation between human and AI assistant.
[|Human|] I have RA and have been injecting 7.5 ml once a week followed by leucovorin 5 mg tab 12 hours after methotrexate. I have been suffering from a cough for 3 weeks. My Family Practicianer prescribed medicine for reflux and allergies, since I did not feel sick except the cough. Another week went by and my cough is worse and I am now coughing up some phlem, but not much. So now I am on azithromycin. My blood tests taken a couple of weeks ago all appeared normal except wbc is approaching the level of being low. I have not ran a fever. My question is when should I be concerned that my severe, non stopping cough is due to methotrexate toxity.
[|AI|]  Hello dear, thanks for your question on Chat Doctor. I can understand your situation and problem. I advise you consult pulmonologist and get done1. Chest x ray2. CT thorax if needed.3. PUT (pulmonary function test). Since your cough is not improved with treatment, and you are developing fever with phlegm (mucus) production, these suggest either of the following.1. Lung infection (pneumonia)2. Methotrexate toxicity3. RA associated pulmonary complications like bronchitis, fibrosis,infiltration etc. So chest x-ray, CT thorax (if needed) and PFT are needed to rule out above possible causes. So consult pulmonologist and discuss all these.