title: Methotrexate-associated lymphoproliferative disorder in a patient with rheumatoid arthritis presenting in the skin.
abstract: 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.
authors.affiliation: Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, USA. lorenclarke@comcast.net
authors.forename: Loren E
authors.initials: LE
authors.lastname: Clarke
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Junkins-Hopkins
authors.forename: John T
authors.initials: JT
authors.lastname: Seykora
authors.forename: Donald J
authors.initials: DJ
authors.lastname: Adler
authors.forename: Rosalie
authors.initials: R
authors.lastname: Elenitsas
mesh_terms: 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
chemical_list: D018501:Antirheumatic Agents; D008727:Methotrexate