title: Atypical methotrexate ulcerative stomatitis with features of lymphoproliferative like disorder: Report of a rare ciprofloxacin-induced case and review of the literature.
abstract: Methotrexate (MTX) is an established immunomodulating agent used in low doses (LDMTX) to treat several autoimmune diseases. Ulcerative stomatitis (US) may be observed as a long-term LDMTX adverse effect showing a wide histopathologic spectrum. A 73-year old female presented with painful oral ulcers of 5 days duration. The patient had been under treatment for rheumatoid arthritis with LDMTX, while one week before presentation she was prescribed ciprofloxacin for a urinary infection. Histopathologic examination of a lingual ulcer revealed a polymorphous lymphohistiocytic proliferation with scattered binucleated atypical lymphocytes. Immunohistochemically, most cells were of T-cell lineage while the EBER test was negative and a diagnosis of MTX-induced reactive ulceration was rendered. MTX cessation resulted in complete resolution of the ulcers with no recurrences reported so far. The clinical and histopathologic features of MTX-induced oral ulcers are not always diagnostic and a detailed history and an extensive clinicopathologic investigation may be needed to exclude a lymphoproliferative disorder.Key words:Atypical oral ulcers, ciprofloxacin, lymphoproliferative disorders, methotrexate.
authors.affiliation: DDS, MSc, MSc in Oral Medicine and Pathology, Department of Oral Medicine and Oral Pathology, School of Dentistry, National and Kapodistrian University of Athens, Athens, Greece.
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Katsoulas
authors.affiliation: DDS, PhD, Assistant Professor, Department of Oral Medicine and Oral Pathology, School of Dentistry, National and Kapodistrian University of Athens, Athens, Greece.
authors.forename: Evanthia
authors.initials: E
authors.lastname: Chrysomali
authors.affiliation: DDS, MSc, PhD, Assistant Professor, Department of Oral Medicine and Oral Pathology, School of Dentistry, National and Kapodistrian University of Athens, Athens, Greece.
authors.forename: Evangelia
authors.initials: E
authors.lastname: Piperi
authors.affiliation: MD, PhD, Consultant Hematopathologist, 1st Department of Pathology, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.
authors.forename: Georgia
authors.initials: G
authors.lastname: Levidou
authors.affiliation: DDS, MSc, PhD, Professor, Department of Oral Medicine and Oral Pathology, School of Dentistry, National and Kapodistrian University of Athens, Athens, Greece.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Sklavounou-Andrikopoulou