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Methotrexate-induced iatrogenic immunodeficiency-associated lymphoproliferative disorder causing hypercalcaemia
Monica Lee1, Khoa Anh Nguyen1, Robert Kaplan1
1Internal Medicine, Irvine School of Medicine, University of California, Irvine, California, USA.
BMJ Case Reports
|June 3, 2019
Summary
Chronic methotrexate use can lead to lymphoproliferative disorders (LPDs) and hypercalcemia. Stopping immunosuppressive drugs corrected the patient's high calcium levels, highlighting a crucial clinical consideration.
Area of Science:
- Oncology
- Immunology
- Pharmacology
Background:
- Hypercalcemia is a serious complication of malignancy, often linked to solid tumors like lymphomas.
- Mechanisms include parathyroid hormone-related protein and ectopic 1alpha-hydroxylase production.
- Chronic immunosuppressive therapy, such as methotrexate (MTX), can be associated with lymphoproliferative disorders (LPDs).
Observation:
- A 56-year-old woman with Sjogren's syndrome and psoriasis, on chronic methotrexate (MTX) therapy, presented with escalating hypercalcemia and lymphoma-like symptoms.
- Pathological examination revealed MTX-induced iatrogenic immunodeficiency-associated lymphoproliferative disorder (LPD).
Findings:
- Chronic methotrexate use is a recognized risk factor for developing lymphoproliferative disorders (LPDs).
- MTX-associated LPD can manifest as severe hypercalcemia, mimicking malignancy-related hypercalcemia.
Implications:
- This case highlights the importance of considering MTX-induced LPD in patients on long-term therapy presenting with hypercalcemia.
- Discontinuation of immunosuppressive agents, alongside supportive care (fluids, calcitonin), can effectively manage MTX-induced hypercalcemia and LPD.
- Prompt diagnosis and management led to the patient's recovery and partial remission.
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