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Methotrexate-associated lymphoproliferative disorder complicated by severe acute respiratory failure and ileal

Eiji Suzuki1, Takashi Kanno1, Satoru Kimura2

  • 1Department of Rheumatology, Ohta-Nishinouchi Hospital.

Fukushima Journal of Medical Science
|June 22, 2018
PubMed

Insights

Methotrexate (MTX) can cause lymphoproliferative disorder (LPD) in rheumatoid arthritis (RA) patients. Early MTX cessation is crucial for managing MTX-associated LPD, which can present with severe complications like intestinal perforation.

Area of Science:

  • Rheumatology
  • Oncology
  • Pathology

Background:

  • Methotrexate (MTX) is a common disease-modifying antirheumatic drug (DMARD) used for rheumatoid arthritis (RA).
  • Lymphoproliferative disorder (LPD) is a recognized, albeit rare, adverse effect associated with MTX therapy.
  • MTX-associated LPD (MTX-LPD) can manifest with diverse and severe clinical presentations.

Observation:

  • A 61-year-old female RA patient on MTX presented with dyspnea and abdominal pain.
  • She was diagnosed with intestinal perforation and peritonitis, requiring emergency surgery.
  • Surgical specimens and bone marrow biopsy confirmed diffuse large B-cell lymphoma.

Findings:

  • The patient experienced severe pulmonary failure, unresponsive to steroid therapy.
  • Discontinuation of MTX and abdominal surgery led to clinical improvement.
  • Histopathological analysis confirmed MTX-LPD, specifically diffuse large B-cell lymphoma.

Implications:

  • MTX-LPD poses a risk of life-threatening complications in RA patients.
  • Variable clinical presentations necessitate high suspicion for MTX-LPD.
  • Prompt MTX withdrawal is critical upon suspicion of MTX-LPD to improve patient outcomes.
Keywords:
intestinal perforationmethotrexatemethotrexate-associated lymphoproliferative disorderrespiratory failurerheumatoid arthritis

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