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Lymphoproliferative disorder in an elderly rheumatoid arthritis patient after longterm oral methotrexate

Kazuhiko Hashimoto1, Masao Akagi1

  • 1Department of Orthopedic Surgery, Kindai University Hospital, Osaka-Sayama, Osaka 589-8511, Japan.

Molecular and Clinical Oncology
|August 30, 2018
PubMed

Insights

Methotrexate-associated lymphoproliferative disorder (MTX-LPD) can occur in patients with rheumatoid arthritis on long-term methotrexate treatment. Discontinuing methotrexate led to symptom improvement and mass reduction in a case study.

Area of Science:

  • Rheumatology
  • Oncology
  • Pathophysiology

Background:

  • Methotrexate-associated lymphoproliferative disorder (MTX-LPD) is a known complication in patients undergoing long-term methotrexate therapy.
  • The exact pathophysiology of MTX-LPD remains incompletely understood.
  • Rheumatoid arthritis (RA) patients are particularly susceptible due to prolonged methotrexate use.

Purpose of the Study:

  • To present a case of MTX-LPD in a patient with a history of rheumatoid arthritis.
  • To highlight the clinical presentation and diagnostic process of MTX-LPD.
  • To emphasize the importance of considering MTX-LPD in differential diagnoses for RA patients on methotrexate.

Main Methods:

  • Case report of a 67-year-old Japanese woman with RA on long-term oral methotrexate.
  • Clinical presentation included generalized neck lymphadenopathy.
  • Diagnosis of diffuse large B-cell lymphoma confirmed via biopsy.

Main Results:

  • The patient had a 20-year history of oral methotrexate treatment for RA.
  • Biopsy confirmed diffuse large B-cell lymphoma.
  • Discontinuation of methotrexate resulted in significant reduction of lymphadenopathy and symptom improvement.

Conclusions:

  • MTX-LPD should be considered in the differential diagnosis of patients with rheumatological conditions on long-term methotrexate therapy.
  • Early recognition and discontinuation of methotrexate can lead to favorable outcomes.
  • Awareness among clinicians is crucial for timely diagnosis and management of MTX-LPD.
Keywords:
elderlylong-term oral administrationmethotrexate-associated lymphoproliferative disorderrheumatoid arthritis

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