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Methotrexate-Associated Lymphoproliferative Disorder: Dermoscopic Features.

Takeshi Namiki1, Yumiko Sone1, Keiko Miura2

  • 1Department of Dermatology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan.

Case Reports in Dermatology
|June 22, 2018
PubMed
Summary

Methotrexate-related lymphoproliferative disorder (MTX-LPD) presents unique dermoscopic findings, including dotted and glomerular vessels. Discontinuation of methotrexate therapy led to symptom improvement, suggesting its diagnostic utility.

Keywords:
DermoscopyEpstein-Barr virusLymphoproliferative disorderMethotrexate

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Area of Science:

  • Dermatology
  • Oncology
  • Rheumatology

Background:

  • Methotrexate (MTX) is a common therapy for autoimmune diseases.
  • Long-term MTX use can lead to methotrexate-related lymphoproliferative disorder (MTX-LPD).
  • Dermoscopic features of MTX-LPD have not been previously reported.

Observation:

  • A 64-year-old female with a history of long-term MTX treatment for rheumatoid arthritis presented with a thigh plaque.
  • Dermoscopy revealed dotted and glomerular vessels on pink homogeneous areas with surface scales.
  • Histopathology showed atypical lymphoid cells, telangiectasia, and perivascular inflammation.

Findings:

  • The patient exhibited characteristic dermoscopic findings associated with MTX-LPD.
  • Histopathological examination confirmed the presence of atypical lymphoid cells and vascular changes.
  • Epstein-Barr virus was detected in situ.
  • Cessation of MTX resulted in the regression of skin lesions and lymphadenopathy.

Implications:

  • Dermoscopy may aid in the early diagnosis of MTX-LPD.
  • Understanding these features can help differentiate MTX-LPD from other conditions.
  • Further case accumulation is needed to fully characterize dermoscopic findings of MTX-LPD.