title: Methotrexate-related lymphoproliferative disorder with extensive vascular involvement in a patient with rheumatoid arthritis.
abstract: We describe the development of a cutaneous lymphoproliferative disorder in a patient with rheumatoid arthritis who was treated with methotrexate. Skin manifestations were characterized by thrombophlebitis-like lesions and ulcerated nodules. Histologic examination revealed large polymorphic atypical cells including Reed-Sternberg-like cells expressing CD20 and CD30 in the dermis and subcutaneous tissues. Tumor cells infiltrated the walls of dermal arterioles, subcutaneous arteries, and veins, leading to the destruction of vascular structures. Activation of Epstein-Barr virus was detected. Skin lesions improved remarkably after the discontinuation of methotrexate. This case illustrates the rare occurrence of cutaneous vascular involvement in methotrexate-related lymphoproliferative disorder that did not require any specific chemotherapy.
authors.affiliation: Department of Dermatology, Graduate School, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, Japan.
authors.forename: Chieko
authors.initials: C
authors.lastname: Shimura
authors.forename: Takahiro
authors.initials: T
authors.lastname: Satoh
authors.forename: Kaoru
authors.initials: K
authors.lastname: Takayama
authors.forename: Hiroo
authors.initials: H
authors.lastname: Yokozeki
mesh_terms: D000369:Aged, 80 and over; D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D020031:Epstein-Barr Virus Infections / Q000276:immunology; D005260:Female; D004854:Herpesvirus 4, Human / Q000276:immunology; D006801:Humans; D008232:Lymphoproliferative Disorders / Q000139:chemically induced*; D008727:Methotrexate / Q000009:adverse effects* / Q000627:therapeutic use; D012871:Skin Diseases / Q000139:chemically induced / Q000473:pathology
chemical_list: D008727:Methotrexate