Self-resolution of Epstein-Barr virus-associated B-cell lymphoma in a patient with dermatomyositis following withdrawal of mycophenolate mofetil and methotrexate.
Self-resolving Epstein-Barr virus (EBV)-associated lymphomas have become more common with the use of immunosuppressive agents in both transplant patients and patients with connective tissue disorders. Immunosuppressive agents are often used for control of dermatomyositis, but their use has not been linked to subsequent malignancy. We present a 46-year-old woman with dermatomyositis, who developed an EBV-associated B-cell lymphoma of the brain while on oral methotrexate, mycophenolate mofetil and low-dose prednisone. The patient's lymphoma gradually resolved "spontaneously" upon discontinuation of the methotrexate and mycophenolate mofetil. The potential for EBV-associated B-cell lymphoma to self-resolve should be recognized by the clinician in order to prevent unnecessary and potentially toxic treatments including radiation therapy or multi-drug chemotherapy.
Waldman
Mark A
MA
Division of Dermatology, Department of Medicine, University of Louisville School of Medicine, Louisville, Kentucky, USA.
Callen
Jeffrey P
JP
D001706:Biopsy; D001932:Brain Neoplasms / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy*; D002051:Burkitt Lymphoma / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy*; D003882:Dermatomyositis / Q000150:complications / Q000188:drug therapy*; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000009:adverse effects*; D008279:Magnetic Resonance Imaging; D008297:Male; D008727:Methotrexate / Q000008:administration & dosage / Q000009:adverse effects; D008875:Middle Aged; D009173:Mycophenolic Acid / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*; D011241:Prednisone / Q000008:administration & dosage; D012074:Remission Induction; D028761:Withholding Treatment
D007166:Immunosuppressive Agents; D009173:Mycophenolic Acid; D011241:Prednisone; D008727:Methotrexate