Methotrexate-associated lymphoproliferative disorder in a patient with rheumatoid arthritis presenting in the skin.
A 91-year-old woman who had been taking methotrexate for approximately 5 years for rheumatoid arthritis developed papules and nodules on her face that enlarged during 6 months. A series of biopsy specimens demonstrated a lymphoplasmacytic infiltrate with increasingly atypical histopathologic features that resembled diffuse large B-cell lymphoma. Epstein-Barr virus was not identified. Withdrawal of methotrexate resulted in complete resolution of all lesions within 8 weeks. This case illustrates the rare occurrence of methotrexate-associated lymphoproliferative disorder with primary presentation in the skin and documents clinical and histopathologic progression from early changes to fully developed lesions.
Clarke
Loren E
LE
Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, USA. lorenclarke@comcast.net
Junkins-Hopkins
Jacqueline
J
Seykora
John T
JT
Adler
Donald J
DJ
Elenitsas
Rosalie
R
D000369:Aged, 80 and over; D018501:Antirheumatic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000175:diagnosis / Q000188:drug therapy*; D001707:Biopsy, Needle; D005148:Facial Dermatoses / Q000139:chemically induced* / Q000473:pathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007150:Immunohistochemistry; D008134:Long-Term Care; D008232:Lymphoproliferative Disorders / Q000139:chemically induced* / Q000473:pathology; D008727:Methotrexate / Q000009:adverse effects* / Q000627:therapeutic use; D018570:Risk Assessment
D018501:Antirheumatic Agents; D008727:Methotrexate