Epstein-Barr virus-associated Hodgkin's lymphoma and legionella pneumophila infection complicating treatment of juvenile rheumatoid arthritis with methotrexate and cyclosporine A.
We describe the case of a 53-month-old girl with juvenile rheumatoid arthritis (JRA), complicated by the occurrence of Hodgkin's lymphoma and Legionella pneumophila infection during immunosuppressive treatment with methotrexate (MTX) and cyclosporine A (CSA). The girl had received variable anti-inflammatory combination therapy, including MTX for 28 months and CSA for 3 months. Thirty-six months after the onset of arthritis, the girl presented with an enlargement of the lymph nodes of the mediastinum, the hilum of the lungs, and the abdomen. Concomitantly, a diagnosis of Legionella pneumonia was rendered. Autopsy showed Epstein-Barr virus (EBV)-associated nodular sclerosing Hodgkin's lymphoma. The neoplastic cells were positive for CD15, CD 30, and latent membrane protein 1 (LMP 1). The present case is the second reported to occur in a child, and it lends support to the hypothesis that immunosuppressive treatment may contribute to an increased risk of the development of EBV-associated lymphoproliferative disorders (LPD) in pediatric patients suffering from JRA.
Krugmann
J
J
Department of Pathology, University of Innsbruck, School of Medicine, Austria.
Sailer-Höck
M
M
Müller
T
T
Gruber
J
J
Allerberger
F
F
Offner
F A
FA
D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D016572:Cyclosporine / Q000009:adverse effects; D020031:Epstein-Barr Virus Infections / Q000209:etiology*; D017809:Fatal Outcome; D005260:Female; D006689:Hodgkin Disease / Q000821:virology*; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects* / Q000627:therapeutic use; D007223:Infant; D007877:Legionnaires' Disease / Q000209:etiology*; D008727:Methotrexate / Q000009:adverse effects
D007166:Immunosuppressive Agents; D016572:Cyclosporine; D008727:Methotrexate