Malignant lymphoma associated with rheumatoid arthritis, developing shortly after initiation of oral methotrexate.
We report a patient with rheumatoid arthritis (RA) who developed malignant lymphoma of the diffuse large B-cell type in the right submandibular region shortly after initiation of oral methotrexate (MTX). Despite cessation of MTX, the lymphadenopathy did not regress, and only reached complete remission after 3 courses of CHOP therapy followed by irradiation. In this patient highly active RA itself was considered to be the main cause of malignant lymphoma, and MTX might have contributed to the development by modifying the immune system. When RA is highly active, MTX should be used carefully because of the possible development of malignant lymphoma as well as other serious complications.
Third Department of Medicine, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto 390-8621.
Takahisa
T
Gono
Yasuhiro
Y
Shimojima
Kenichi
K
Hoshi
Kanji
K
Yamamoto
Takahiko
T
Tokuda
Naoto
N
Shikama
Masayuki
M
Matsuda
Shu-ichi
S
Ikeda
D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D018501:Antirheumatic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000150:complications* / Q000188:drug therapy*; D003520:Cyclophosphamide / Q000627:therapeutic use; D004317:Doxorubicin / Q000627:therapeutic use; D006801:Humans; D016393:Lymphoma, B-Cell / Q000188:drug therapy / Q000209:etiology*; D016403:Lymphoma, Large B-Cell, Diffuse / Q000188:drug therapy / Q000209:etiology*; D008279:Magnetic Resonance Imaging; D008297:Male; D008339:Mandibular Neoplasms / Q000188:drug therapy / Q000209:etiology; D008727:Methotrexate / Q000009:adverse effects / Q000627:therapeutic use*; D008875:Middle Aged; D011239:Prednisolone / Q000627:therapeutic use; D014750:Vincristine / Q000627:therapeutic use
D018501:Antirheumatic Agents; D014750:Vincristine; D004317:Doxorubicin; D003520:Cyclophosphamide; D011239:Prednisolone; D008727:Methotrexate