Epstein-Barr virus-positive oral ulceration simulating Hodgkin lymphoma in a patient treated with methotrexate: case report and review of the literature.
Immunosuppressive therapy for patients diagnosed with rheumatoid arthritis has long been implicated in the development of various neoplastic processes, including leukemia and lymphoma. Methotrexate is a commonly administered antimetabolic medication thought to improve the symptoms of rheumatoid arthritis through its anti-inflammatory effects. Longterm methotrexate therapy and concurrent rheumatoid arthritis have both been independently suggested as risk factors for developing lymphoma. The mechanism has been theorized to be severe immunosuppression and an increased frequency of latent infection with pro-oncogenic viruses, such as the Epstein-Barr virus (EBV). Spontaneous remission of these malignancies has been seen after discontinuation of the methotrexate therapy. In the present study, we report the case of a patient diagnosed with rheumatoid arthritis and treated with methotrexate and prednisone. She developed intraoral ulcerations that histopathologically resembled Hodgkin's lymphoma.
Assistant Professor, Department of Diagnostic Sciences, Texas A&M University Baylor College of Dentistry, Dallas, TX. Electronic address: anaidu@bcd.tamhsc.edu.
Aparna
A
Naidu
Professor, Department of Diagnostic Sciences, Texas A&M University Baylor College of Dentistry, Dallas, TX.
Harvey P
HP
Kessler
Clinical Professor, Department of Oral and Maxillofacial Surgery, Texas A&M University Baylor College of Dentistry, Dallas, TX.
Miro A
MA
Pavelka
D000369:Aged, 80 and over; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D018501:Antirheumatic Agents / Q000009:adverse effects*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy; D003937:Diagnosis, Differential; D020031:Epstein-Barr Virus Infections / Q000175:diagnosis*; D005260:Female; D005500:Follow-Up Studies; D005882:Gingival Diseases / Q000139:chemically induced; D006689:Hodgkin Disease / Q000175:diagnosis*; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects; D008727:Methotrexate / Q000009:adverse effects*; D019226:Oral Ulcer / Q000821:virology*; D011241:Prednisone / Q000627:therapeutic use
D000893:Anti-Inflammatory Agents; D018501:Antirheumatic Agents; D007166:Immunosuppressive Agents; D011241:Prednisone; D008727:Methotrexate