title: Lymphomatoid granulomatosis and diffuse alveolar damage associated with methotrexate therapy in a patient with rheumatoid arthritis.
abstract: We report on a patient of rheumatoid arthritis (RA) who sequentially developed an axillary mass and a fatal interstitial pneumonia during a 2-year course of methotrexate (MTX) therapy. Autopsy revealed a systemic lymph node involvement and the diagnosis of Epstein-Barr virus (EBV)-related lymphoproliferative disease (LPD) with the features of lymphomatoid granulomatosis was made. The lung tissue specimens revealed a typical diffuse alveolar damage (DAD), and small nodules consisting of atypical B lymphocytes showing positive staining for EBV were sparsely recognized only in basal lungs. This is the first report of a RA patient receiving MTX therapy sequentially developing MTX-associated lymphomatoid granulomatosis and DAD.
authors.affiliation: Division of Rheumatology/Clinical Immunology, Department of Internal Medicine, Saitama Medical Center, Saitama Medical University, 1981 Tsujido-machi, Kamoda, Kawagoe, Saitama 350-8550, Japan. kamehide@saitama-med.ac.jp
authors.forename: Hideto
authors.initials: H
authors.lastname: Kameda
authors.forename: Ayumi
authors.initials: A
authors.lastname: Okuyama
authors.forename: Jun-Ichi
authors.initials: J
authors.lastname: Tamaru
authors.forename: Shinji
authors.initials: S
authors.lastname: Itoyama
authors.forename: Atsushi
authors.initials: A
authors.lastname: Iizuka
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Takeuchi
mesh_terms: D000368:Aged; D001172:Arthritis, Rheumatoid / Q000188:drug therapy; D020031:Epstein-Barr Virus Infections / Q000139:chemically induced* / Q000150:complications; D017809:Fatal Outcome; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects* / Q000627:therapeutic use; D008230:Lymphomatoid Granulomatosis / Q000209:etiology; D008232:Lymphoproliferative Disorders / Q000139:chemically induced* / Q000821:virology*; D008297:Male; D008727:Methotrexate / Q000009:adverse effects* / Q000627:therapeutic use; D011014:Pneumonia / Q000139:chemically induced; D011650:Pulmonary Alveoli / Q000473:pathology / Q000821:virology
chemical_list: D007166:Immunosuppressive Agents; D008727:Methotrexate