[Methotrexate-associated lymphoproliferative disorder presenting as oral ulcers in a patient with rheumatoid arthritis].
Methotrexate-associated lymphoproliferative disorders are a heterogeneous group of lymphoid proliferations or lymphomas that develop in patients with autoimmune diseases treated using methotrexate. These lymphoproliferative disorders are often associated with Epstein-Barr virus infection and occasionally regress after the withdrawal of methotrexate therapy. The lymphoproliferative disorder in this case was diffuse large B-cell lymphoma, unusually presenting as oral ulcers in a 79-year-old woman on treatment with methotrexate for longstanding rheumatoid arthritis. Latent membrane protein 1 positivity was detected by immunohistochemistry and Epstein-Barr-virus encoded small RNA positivity by chromogenic in situ hybridization. Clonality was confirmed by immunohistochemistry (kappa light-chain restriction), polymerase chain reaction (monoclonal immunoglobulin H gene rearrangement), and capillary electrophoresis (GeneScan). Staging procedures were negative. Withdrawal of methotrexate therapy led to complete remission within 6 weeks, and the patient is alive and disease-free 18 months after the diagnosis was made. The oral cavity is not often involved in the initial presentation of methotrexate-associated lymphoproliferative disorders, and presentation with intraoral ulcers is very rare. We have performed a review of the literature on methotrexate-associated lymphoproliferative disorders presenting as ulcers in the oral cavity.
Pastor-Nieto
María Antonia
MA
Servicio de Dermatología, Hospital General Universitario de Guadalajara, Guadalajara, España. tonales@terra.es
Kilmurray
L G
LG
López-Chumillas
A
A
O'Valle
F
F
García-Del Moral
R
R
Puig
A M
AM
Bautista
P
P
D000368:Aged; D015703:Antigens, CD / Q000032:analysis; D000951:Antigens, Neoplasm / Q000032:analysis; D001172:Arthritis, Rheumatoid / Q000150:complications / Q000188:drug therapy*; D014408:Biomarkers, Tumor / Q000032:analysis; D020031:Epstein-Barr Virus Infections / Q000150:complications; D005260:Female; D015326:Gene Rearrangement, B-Lymphocyte, Heavy Chain; D004854:Herpesvirus 4, Human / Q000302:isolation & purification; D006801:Humans; D016867:Immunocompromised Host; D007145:Immunoglobulin kappa-Chains / Q000032:analysis; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D016403:Lymphoma, Large B-Cell, Diffuse / Q000737:chemistry / Q000209:etiology* / Q000473:pathology / Q000821:virology; D008727:Methotrexate / Q000009:adverse effects*; D019226:Oral Ulcer / Q000209:etiology* / Q000473:pathology; D012074:Remission Induction
D015703:Antigens, CD; D000951:Antigens, Neoplasm; D014408:Biomarkers, Tumor; D007145:Immunoglobulin kappa-Chains; D007166:Immunosuppressive Agents; D008727:Methotrexate