Reversible methotrexate associated lymphoproliferative disease evolving into Hodgkin's disease.
We describe a case of nodular sclerosing Hodgkin's disease (NSHD) developing in a 61-year-old woman with seropositive rheumatoid arthritis treated with oral methotrexate (MTX) 5 to 15 mg/week for 5 years. Computed tomography (CT) of the abdomen revealed splenomegaly and marked abdominal and retroperitoneal lymphadenopathy. MTX was discontinued; several weeks later prednisone 10 mg/day was added to control worsening polyarthralgia. Repeat CT at 3 months showed almost complete regression of the splenomegaly and lymphadenopathy. However, CT studies at 10 months showed asymptomatic progression of lymphadenopathy, which on biopsy revealed NSHD. Patients with apparently reversible MTX associated lymphoproliferative disorder require periodic monitoring for asymptomatic development of malignant lymphoma.
Moseley
A C
AC
Department of Medicine, University of Kansas Medical Center, Kansas City 66160, USA.
Lindsley
H B
HB
Skikne
B S
BS
Tawfik
O
O
D018501:Antirheumatic Agents / Q000009:adverse effects*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy; D018450:Disease Progression; D005260:Female; D004854:Herpesvirus 4, Human / Q000502:physiology; D006689:Hodgkin Disease / Q000209:etiology* / Q000473:pathology / Q000821:virology; D006801:Humans; D008232:Lymphoproliferative Disorders / Q000139:chemically induced* / Q000150:complications* / Q000000981:diagnostic imaging; D008727:Methotrexate / Q000009:adverse effects*; D008875:Middle Aged; D014057:Tomography, X-Ray Computed; D014775:Virus Activation
D018501:Antirheumatic Agents; D008727:Methotrexate