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Epstein-Barr virus and methotrexate-related CNS lymphoma in a patient with rheumatoid arthritis

Kiyoshi Migita1, Taiichiro Miyashita, Toma Mijin

  • 1Department of General Internal Medicine and Rheumatology, Clinical Research Center, NHO National Nagasaki Medical Center, Kubara 2-1001-1, Omura 856-8652, Japan. migita@nmc.hosp.go.jp

Modern Rheumatology
|July 25, 2012
PubMed

Insights

Rheumatoid arthritis patients on methotrexate may face higher risks of Epstein-Barr virus-associated lymphomas. This case highlights a potential link between methotrexate, immunosuppression, and EBV-positive CNS lymphoma in RA patients.

Area of Science:

  • Oncology
  • Immunology
  • Rheumatology

Background:

  • Rheumatoid arthritis (RA) patients, particularly those on methotrexate (MTX), may have an increased risk of lymphoproliferative disorders.
  • Epstein-Barr virus (EBV) is associated with certain lymphoproliferative disorders.

Observation:

  • A case of EBV-associated central nervous system (CNS) lymphoma (diffuse large B-cell lymphoma) is described in an RA patient.
  • The patient received a short course of MTX treatment.

Findings:

  • Neoplastic cells expressed B-cell surface markers (CD20, Pax-5, CD30).
  • EBV-encoded RNA was detected via in situ hybridization.
  • The lymphoma did not recur during an 8-year follow-up after tumor resection and MTX cessation.

Implications:

  • Methotrexate's immunosuppressive properties may promote EBV-positive CNS lymphoma in RA patients.
  • MTX might reactivate latent EBV infection, contributing to lymphomagenesis.
  • This case underscores the importance of monitoring for lymphoproliferative disorders in RA patients on immunosuppressive therapy.

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