title: CD8-positive T-cell lymphoproliferative disorder associated with Epstein-Barr virus-infected B-cells in a rheumatoid arthritis patient under methotrexate treatment.
abstract: We report a 48-year-old female who developed lymphoproliferative disorder (LPD) during treatment of rheumatoid arthritis (RA) with methotrexate (MTX). She presented with multiple tumors in the cervical lymph nodes (LNs), multiple lung shadows and round shadows in both kidneys with pancytopenia and a high CRP level. The LN showed CD8-positive T-cell LPD associated with Epstein-Barr (EB) virus-infected B-cells. Clonality assays for immunoglobulin (Ig) heavy chain and T-cell receptor gamma (TCRγ) were negative. The cessation of MTX without chemotherapy resulted in the complete disappearance of the tumors and abnormal clinical features. We compared this case with previously published ones and discuss the pathological findings, presuming that the proliferation of CD8 T-cells was a reactive manifestation to reactivated EB virus-infected B-cells.
authors.affiliation: a First Department of Internal Medicine , Kyorin University School of Medicine , Mitaka, Tokyo , Japan.
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Koji
authors.affiliation: b Department of Pathology , Kyorin University School of Medicine , Mitaka, Tokyo , Japan.
authors.forename: Takuya
authors.initials: T
authors.lastname: Yazawa
authors.affiliation: a First Department of Internal Medicine , Kyorin University School of Medicine , Mitaka, Tokyo , Japan.
authors.forename: Kimimasa
authors.initials: K
authors.lastname: Nakabayashi
authors.affiliation: b Department of Pathology , Kyorin University School of Medicine , Mitaka, Tokyo , Japan.
authors.forename: Yasunori
authors.initials: Y
authors.lastname: Fujioka
authors.affiliation: b Department of Pathology , Kyorin University School of Medicine , Mitaka, Tokyo , Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Kamma
authors.affiliation: a First Department of Internal Medicine , Kyorin University School of Medicine , Mitaka, Tokyo , Japan.
authors.forename: Akira
authors.initials: A
authors.lastname: Yamada
mesh_terms: D001172:Arthritis, Rheumatoid / Q000150:complications / Q000188:drug therapy* / Q000473:pathology; D001402:B-Lymphocytes / Q000473:pathology / Q000821:virology*; D018414:CD8-Positive T-Lymphocytes; D020031:Epstein-Barr Virus Infections / Q000150:complications* / Q000473:pathology; D005260:Female; D004854:Herpesvirus 4, Human; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology; D008232:Lymphoproliferative Disorders / Q000150:complications* / Q000473:pathology; D008727:Methotrexate / Q000627:therapeutic use*; D008875:Middle Aged
chemical_list: D008727:Methotrexate
keywords: CD8-positive T-cell; Epstein-Barr virus; Lymphoproliferative disorder; Methotrexate; Rheumatoid arthritis