Epstein-Barr virus-associated lymphoproliferative disease during methotrexate therapy for psoriasis.
BACKGROUND
Epstein-Barr virus (EBV)-associated lymphoproliferative disorders have recently been observed during treatment of rheumatoid arthritis and dermatomyositis with low-dose methotrexate.


METHODS
A patient with psoriasis developed a B-cell lymphoproliferative disorder during long-term treatment with low-dose methotrexate. The lymphoid cells expressed EBV latent membrane protein 1, and the EBV viral genome was present as demonstrated by in situ hybridization. Evaluation for EBV clonality showed that the lymph node contained clonal EBV DNA. Polymerase chain reaction studies confirmed that the B-cell lymphoproliferative disorder was mainly monoclonal, suggesting that the disorder arose from a single EBV-infected B-cell clone.


CONCLUSIONS
Lymphoproliferative disorders associated with Epstein-Barr virus in which the clinicopathological presentation is similar to those occurring in patients after transplantation may be observed in patients with psoriasis treated with methotrexate. While it is impossible to rule out a fortuitous occurrence of an EBV-associated lymphoproliferative disorder and psoriasis treated with methotrexate in the same patient, EBV appears to be critical in the pathogenesis of the lymphoproliferative disorder in this patient.
Paul
C
C
Department of Dermatology, Hôpital Saint Louis, Paris, France.
Le Tourneau
A
A
Cayuela
J M
JM
Devidas
A
A
Robert
C
C
Molinié
V
V
Dubertret
L
L
D000956:Antigens, Viral / Q000032:analysis; D001402:B-Lymphocytes / Q000473:pathology / Q000821:virology; D015139:Blotting, Southern; D002213:Capsid / Q000032:analysis; D004279:DNA, Viral / Q000032:analysis; D003879:Dermatologic Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D015334:Gene Rearrangement, gamma-Chain T-Cell Antigen Receptor; D016679:Genome, Viral; D004854:Herpesvirus 4, Human / Q000235:genetics; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D017403:In Situ Hybridization; D016393:Lymphoma, B-Cell / Q000473:pathology / Q000821:virology*; D016403:Lymphoma, Large B-Cell, Diffuse / Q000473:pathology / Q000821:virology*; D008297:Male; D008727:Methotrexate / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D008875:Middle Aged; D009856:Oncogene Proteins, Viral / Q000032:analysis; D016133:Polymerase Chain Reaction; D011565:Psoriasis / Q000188:drug therapy*; D014763:Viral Matrix Proteins / Q000032:analysis
D000956:Antigens, Viral; D004279:DNA, Viral; D003879:Dermatologic Agents; C037662:EBV-associated membrane antigen, Epstein-Barr virus; D007166:Immunosuppressive Agents; D009856:Oncogene Proteins, Viral; D014763:Viral Matrix Proteins; D008727:Methotrexate