title: Methotrexate-related lymphoproliferative disorder arising in the gingiva of a patient with rheumatoid arthritis.
abstract: Methotrexate (MTX) is the primary drug used in the management of rheumatoid arthritis (RA) and other immune-mediated inflammatory diseases. MTX is a strong immunosuppressive agent and has been reported to cause iatrogenic immunodeficiency-associated lymphoproliferative disorders (LPDs). Stomatitis caused by MTX-related cytotoxicity may occur, but gingival MTX-related LPDs are rare. In this article we present a case of gingival MTX-related LPD in a 60-year-old male with RA. The local findings of the gingival ulceration and alveolar bone exposure were similar to those of bisphosphonate-related osteonecrosis of the jaw. However, he had never received bisphosphonate therapy. The biopsy specimen of the gingival lesion was diagnosed as diffuse large B-cell lymphoma with Epstein-Barr virus positivity. Immediate withdrawal of MTX resulted in marked remission of the LPD.
authors.affiliation: Department of Oral and Maxillofacial Surgery, Saitama Medical Center, Saitama Medical University, Saitama, Japan.
authors.forename: N
authors.initials: N
authors.lastname: Horie
authors.affiliation: Department of Oral and Maxillofacial Surgery, Saitama Medical Center, Saitama Medical University, Saitama, Japan.
authors.forename: R
authors.initials: R
authors.lastname: Kawano
authors.affiliation: Department of Oral and Maxillofacial Surgery, Saitama Medical Center, Saitama Medical University, Saitama, Japan.
authors.forename: T
authors.initials: T
authors.lastname: Kaneko
authors.affiliation: Department of Oral and Maxillofacial Surgery, Saitama Medical Center, Saitama Medical University, Saitama, Japan.
authors.forename: T
authors.initials: T
authors.lastname: Shimoyama
mesh_terms: D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D020031:Epstein-Barr Virus Infections / Q000175:diagnosis*; D005887:Gingival Neoplasms / Q000821:virology*; D004854:Herpesvirus 4, Human / Q000302:isolation & purification*; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D016403:Lymphoma, Large B-Cell, Diffuse / Q000821:virology*; D008297:Male; D008727:Methotrexate / Q000009:adverse effects*; D008875:Middle Aged; D019226:Oral Ulcer / Q000821:virology; D010020:Osteonecrosis / Q000821:virology
chemical_list: D007166:Immunosuppressive Agents; D008727:Methotrexate
keywords: Gingiva; lymphoproliferative disorder; methotrexate