Cutaneous lymphoma associated with Epstein-Barr virus infection in 2 patients treated with methotrexate.
Whether patients with rheumatoid arthritis (RA) have an increased risk of developing non-Hodgkin lymphoma is controversial, and opinions differ on the possible role of methotrexate in the occurrence of lymphomas in patients with RA. We report 1 T-cell lymphoma and 1 B-cell lymphoma restricted to the skin associated with Epstein-Barr virus infection that healed completely and spontaneously after discontinuation of methotrexate in a man with RA and a woman with dermatomyositis. Cutaneous infiltrating cells were infected by a replicative form of Epstein-Barr virus. After discontinuation of methotrexate, the cutaneous lesions disappeared completely in 15 days without recurrence. Discontinuation of methotrexate is necessary in patients with RA or dermatomyositis who have a lymphoproliferative disorder, and a follow-up period of several weeks should be observed before specific therapy is initiated.
Tournadre
A
A
Department of Rheumatology, Hĵpital Gabriel Montpied, Clermont-Ferrand, France.
D'Incan
M
M
Dubost
J J
JJ
Franck
F
F
Déchelotte
P
P
Souteyrand
P
P
Soubrier
M
M
D000368:Aged; D018501:Antirheumatic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000188:drug therapy; D002051:Burkitt Lymphoma / Q000473:pathology / Q000821:virology*; D003879:Dermatologic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D003882:Dermatomyositis / Q000188:drug therapy; D020031:Epstein-Barr Virus Infections / Q000150:complications* / Q000473:pathology; D005260:Female; D004854:Herpesvirus 4, Human / Q000235:genetics / Q000302:isolation & purification*; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects* / Q000627:therapeutic use; D017403:In Situ Hybridization; D016410:Lymphoma, T-Cell, Cutaneous / Q000473:pathology / Q000821:virology*; D008297:Male; D008727:Methotrexate / Q000009:adverse effects* / Q000627:therapeutic use; D008875:Middle Aged; D012367:RNA, Viral / Q000302:isolation & purification; D012867:Skin / Q000473:pathology* / Q000821:virology
D018501:Antirheumatic Agents; D003879:Dermatologic Agents; D007166:Immunosuppressive Agents; D012367:RNA, Viral; D008727:Methotrexate