title: Successful treatment of immunodeficiency-associated EBV-negative lymphoproliferative disorders in rheumatoid arthritis by methotrexate withdrawal and prevention of its relapse by rituximab administration.
abstract: Immunodeficiency-associated lymphoproliferative disorders (LPD) in rheumatoid arthritis are a rare, aggressive, and life-threatening clinical entity. We describe a 60-year-old man who had rheumatoid arthritis that was treated with methotrexate. Eight months after the treatment, the case was diagnosed as Epstein-Barr virus-negative LPD (diffuse large B-cell lymphoma) with abdominal bulky mass and clinical stage IVB at high risk in the international prognostic index. Immediate withdrawal of methotrexate led the patient to achieve complete remission, and 8 subsequent courses of rituximab treatment for the prevention of relapse kept the patient disease-free for 29 months. Our case suggests that these treatments may be an effective, safe, and feasible strategy for immunodeficiency-associated LPD in rheumatoid arthritis.
authors.affiliation: Internal Medicine, Miyazaki Prefectural Hospital, Miyazaki, Japan. kawanoriaki@yahoo.co.jp
authors.forename: Noriaki
authors.initials: N
authors.lastname: Kawano
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Ono
authors.forename: Shuro
authors.initials: S
authors.lastname: Yoshida
authors.forename: Takuro
authors.initials: T
authors.lastname: Kuriyama
authors.forename: Kiyoshi
authors.initials: K
authors.lastname: Yamashita
authors.forename: Kiichiro
authors.initials: K
authors.lastname: Beppu
authors.forename: Yoshiya
authors.initials: Y
authors.lastname: Shimao
authors.forename: Kosuke
authors.initials: K
authors.lastname: Marutsuka
authors.forename: Yuji
authors.initials: Y
authors.lastname: Ueda
authors.forename: Akira
authors.initials: A
authors.lastname: Ueda
mesh_terms: D058846:Antibodies, Monoclonal, Murine-Derived / Q000494:pharmacology / Q000627:therapeutic use*; D000964:Antimetabolites, Antineoplastic / Q000494:pharmacology / Q000627:therapeutic use; D018501:Antirheumatic Agents / Q000494:pharmacology / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000150:complications / Q000188:drug therapy* / Q000276:immunology; D018572:Disease-Free Survival; D004334:Drug Administration Schedule; D004854:Herpesvirus 4, Human; D006801:Humans; D007153:Immunologic Deficiency Syndromes / Q000150:complications / Q000188:drug therapy* / Q000276:immunology; D016403:Lymphoma, Large B-Cell, Diffuse / Q000188:drug therapy* / Q000209:etiology / Q000276:immunology; D008297:Male; D008727:Methotrexate / Q000494:pharmacology / Q000627:therapeutic use; D008875:Middle Aged; D012008:Recurrence; D000069283:Rituximab
chemical_list: D058846:Antibodies, Monoclonal, Murine-Derived; D000964:Antimetabolites, Antineoplastic; D018501:Antirheumatic Agents; D000069283:Rituximab; D008727:Methotrexate