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Methotrexate-Related Lymphoproliferative Disorder Presenting with Severe Swelling of the Elbow Joint: A Case Report
Takashi Hatano1, Masanobu Ohishi1, Goichi Yoshimoto1
1Departments of Orthopaedic Surgery (T.H., M.O., M.E., T.M., Y.N., K.O., J.-i.F., A.O., and Y.I.), Hematology and Oncology (G.Y.), and Otorhinolaryngology (M.Y.), Kyushu University Hospital, Fukuoka, Japan.
Case:
A patient with rheumatoid arthritis (RA) who was being treated with methotrexate (MTX) therapy presented with severe swelling of the left elbow. Magnetic resonance imaging showed a tumor-like lesion around the elbow joint. Fluorodeoxyglucose positron emission tomography indicated multiple lesions in the lung and the lymph nodes. An open biopsy of a cervical lymph node was performed, and MTX-related lymphoproliferative disorder (MTX-LPD) was diagnosed. After cessation of the MTX therapy, the elbow swelling regressed, and the patient was in remission of MTX-LPD.
Conclusion:
MTX-LPD should be considered in the differential diagnosis when a patient with RA develops severe joint swelling while on MTX therapy.