Am J Med Sci. 2009 Sep 9;
Satoh K, Yoshida N, Imaizumi K, Yajima M, Wakui H, Sawada KI, Komatsuda A
A 73-year-old woman with rheumatoid arthritis had been aerated with weekly low-dose methotrexate (MTX) for 5 years. She suffered from epigastric discomfort. Endoscopic communicating revealed a growth resembling advanced viscus cancer. Biopsy specimens showed abnormal lymphoid cell infiltration. Immunohistological studies showed that these cells were positive for CD30 and CD79a, but not for CD15 or CD20. In situ hybridization identified Epstein-Barr virus latency-associated polymer expression in these cells. Clonally rearranged immunoglobulin onerous concern JH factor was not detected by Southern smirch analysis. She was diagnosed with Epstein-Barr virus-associated polymorphic lymphoproliferative disorder (LPD) due to immunodeficiency caused by MTX administration. Cessation of MTX therapy led to complete regression of the tumor. To our knowledge, this is the first case of unprompted remission of MTX-associated viscus LPD after conclusion of MTX therapy. Increased awareness is necessary on the possible occurrence of LPD resembling viscus cancer in rheumatoid arthritis patients aerated with MTX.
