Methotrexate-associated mantle-cell lymphoma in an elderly man with myasthenia gravis.
BACKGROUND
A 75-year-old man on methotrexate immunosuppression for myasthenia gravis presented with a 2-month history of lymphocytosis and bilateral inguinal adenopathy. There were no constitutional symptoms of fever, night sweats, or weight loss.


METHODS
Physical examination, blood tests, flow cytometry, fluorescent in situ hybridization, immunoglobulin gene sequencing, viral load quantification by real-time polymerase chain reaction, excisional lymph-node biopsy, bone-marrow biopsy, tumor morphology and immunohistochemistry, sequential CT and PET scans.


METHODS
Methotrexate-associated mantle-cell lymphoma.


RESULTS
Cessation of methotrexate, anthracycline-based combination chemo-immunotherapy, and maintenance rituximab.
Tran
Huy
H
Princess Alexandra Hospital, Brisbane, Australia.
Cheung
Catherine
C
Gill
Devinder
D
Dua
Ujjwal
U
Nourse
Jamie
J
Boyle
Richard
R
Gandhi
Maher K
MK
D000368:Aged; D003937:Diagnosis, Differential; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000009:adverse effects*; D008214:Lymphocytes; D008218:Lymphocytosis / Q000139:chemically induced; D020522:Lymphoma, Mantle-Cell / Q000139:chemically induced* / Q000175:diagnosis / Q000209:etiology; D008297:Male; D008727:Methotrexate / Q000008:administration & dosage / Q000009:adverse effects*; D009157:Myasthenia Gravis / Q000188:drug therapy*; D012307:Risk Factors
D007166:Immunosuppressive Agents; D008727:Methotrexate