Epstein-Barr virus-associated lymphoproliferative disease occurring in a patient with sarcoidosis treated by methotrexate and methylprednisolone.
We describe the case of a 51-yr-old man with systemic sarcoidosis, complicated by the occurrence of a lymphoproliferative disease following a 36-month (duration) immunosuppressive treatment with methotrexate (MTX) and methylprednisolone. Four years after the onset of sarcoidosis, the patient presented a large necrotizing anal fistula. Pathological examination of this lesion showed a diffuse polymorphic infiltrate containing large Epstein-Barr virus (EBV)-positive lymphoid cells associated with areas of necrosis, all features similar to classical B-cell lymphoproliferative disorders occurring in immunosuppressed solid-organ recipients. MTX has been recently implicated in the development of lymphoproliferative disease in connective tissue diseases. This case supports the hypothesis that immunosuppression therapy may contribute to an increased risk for the development of EBV-associated lymphoproliferative disorders in patients suffering from sarcoidosis.
Theate
I
I
Department of Pathology, Cliniques Universitaires Saint Luc, Université catholique de Louvain, Avenue Hippocrate 10, B-1200 Brussels, Belgium. Ivan.Theate@clin.ucl.ac.be
Michaux
L
L
Dardenne
S
S
Guiot
Y
Y
Brière
J
J
Emile
F J
FJ
Fabiani
B
B
Detry
R
R
Gaulard
P
P
D000893:Anti-Inflammatory Agents / Q000009:adverse effects / Q000627:therapeutic use; D020031:Epstein-Barr Virus Infections / Q000209:etiology*; D004854:Herpesvirus 4, Human; D006801:Humans; D007165:Immunosuppression Therapy / Q000009:adverse effects*; D007166:Immunosuppressive Agents / Q000009:adverse effects* / Q000627:therapeutic use; D008232:Lymphoproliferative Disorders / Q000209:etiology / Q000821:virology; D008297:Male; D008727:Methotrexate / Q000009:adverse effects* / Q000627:therapeutic use; D008775:Methylprednisolone / Q000009:adverse effects / Q000627:therapeutic use; D008875:Middle Aged; D017565:Sarcoidosis, Pulmonary / Q000150:complications / Q000188:drug therapy*
D000893:Anti-Inflammatory Agents; D007166:Immunosuppressive Agents; D008775:Methylprednisolone; D008727:Methotrexate