title: [A case of iatrogenic immunodeficiency-associated lymphoproliferative disease in a patient treated with methotrexate for rheumatoid arthritis for 9 consecutive years, which Showed natural remission after discontinuation of MTX therapy].
abstract: We report our experience with a case of iatrogenic immunodeficiency-associated lymphoproliferative disease in a patient who had been treated with methotrexate (MTX) for rheumatoid arthritis for 9 consecutive years, which showed natural remission after discontinuation of the MTX therapy. The patient was a 64-year-old woman who was admitted emergently to our hospital with hematemesis and melena. She presented with multiple gastric ulcers and bilateral tonsillitis with a central ulcer. Biopsy of these lesions raised the suspicion of diffuse large B-cell lymphoma. Positron emission tomography (PET)- computed tomography( CT) showed increased fluorodeoxyglucose( FDG) accumulation in the pharynx, cervical lymph nodes, liver, spleen, stomach, distal part of the ileum, and para-aortic lymph nodes, with a maximum standard uptake value of 26.85. Blood test showed elevated lactate dehydrogenase( LDH)( 321 U/L) and interleukin( IL)-2R( 3,531 U/mL) levels. After discontinuation of MTX, the sore throat subsided, and the tonsillitis, lymph node enlargement, and ulcers were resolved. The levels of LDH and IL-2R returned to within the normal range. The patient could be categorized into a regressive disease group with relatively favorable prognosis among patients with MTX-induced lymphoproliferative disease. However, she should continue to be followed up regularly because there remains a possibility that lymphoproliferative disease may relapse after the discontinuation of MTX.
authors.affiliation: Dept. of Surgery, Hasuda Hospital.
authors.forename: Jun
authors.initials: J
authors.lastname: Kaneko
authors.forename: Kazuo
authors.initials: K
authors.lastname: Gozu
authors.forename: Haruhiko
authors.initials: H
authors.lastname: Aoyagi
authors.forename: Toshihiro
authors.initials: T
authors.lastname: Matsui
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Yoshida
authors.forename: Kumi
authors.initials: K
authors.lastname: Hasegawa
authors.forename: Jun
authors.initials: J
authors.lastname: Isogai
authors.forename: Shizuaki
authors.initials: S
authors.lastname: Maejima
mesh_terms: D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000150:complications / Q000188:drug therapy*; D005260:Female; D006801:Humans; D007153:Immunologic Deficiency Syndromes / Q000150:complications* / Q000276:immunology; D008232:Lymphoproliferative Disorders / Q000209:etiology / Q000276:immunology / Q000473:pathology*; D008727:Methotrexate / Q000627:therapeutic use*; D008875:Middle Aged; D013997:Time Factors
chemical_list: D018501:Antirheumatic Agents; D008727:Methotrexate