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Published on: March 30, 2018
Reversible methotrexate associated lymphoproliferative disease evolving into Hodgkin's disease
A C Moseley1, H B Lindsley, B S Skikne
1Department of Medicine, University of Kansas Medical Center, Kansas City 66160, USA.
The Journal of Rheumatology
|April 1, 2000
Summary
Nodular sclerosing Hodgkin's disease developed in a rheumatoid arthritis patient treated with methotrexate. While initially reversible, the lymphoma later progressed, highlighting the need for ongoing monitoring.
Area of Science:
- Oncology
- Rheumatology
- Pathology
Background:
- Rheumatoid arthritis (RA) is an autoimmune disease often treated with disease-modifying antirheumatic drugs (DMARDs).
- Methotrexate (MTX) is a common and effective DMARD for RA, but it carries a risk of iatrogenic lymphoproliferative disorders.
- Lymphoproliferative disorders associated with MTX can sometimes mimic or progress to overt lymphoma.
Observation:
- A 61-year-old woman with seropositive RA on long-term MTX (5-15 mg/week for 5 years) presented with splenomegaly and lymphadenopathy.
- Initial CT scans showed significant abdominal and retroperitoneal lymphadenopathy.
- Discontinuation of MTX and initiation of prednisone led to temporary regression of splenomegaly and lymphadenopathy.
Findings:
- Despite initial improvement after MTX withdrawal, asymptomatic lymphadenopathy recurred at 10 months.
- Biopsy confirmed the recurrence as nodular sclerosing Hodgkin's disease (NSHD).
- This case illustrates the potential for MTX-associated lymphoproliferative disorders to evolve into malignant lymphoma.
Implications:
- Patients with MTX-associated lymphoproliferative disorders require vigilant, long-term surveillance for the development of lymphoma.
- Early detection and monitoring are crucial, as these conditions can progress asymptomatically.
- Understanding the spectrum of MTX-induced lymphoproliferative disorders is essential for optimal patient management in rheumatology and oncology.
