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Reversible cutaneous lymphoma occurring during methotrexate therapy

R Viraben¹, P Brousse, L Lamant

¹Department of Dermatology, Purpan and La Grave Hospital, Toulouse, France.

The British Journal of Dermatology

|July 1, 1996

Summary

Methotrexate treatment for arthritis can trigger B-cell lymphoma and hepatitis, which resolve after stopping the drug. This case highlights drug-induced immune responses and the need for careful monitoring during immunosuppressive therapy.

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Area of Science:

Oncology
Immunology
Dermatology

Background:

Methotrexate (MTX) is a common immunosuppressive drug used for various conditions, including rheumatoid arthritis.
Drug-induced B-cell lymphomas, particularly those associated with Epstein-Barr virus (EBV), are a known complication of long-term immunosuppression.
Simultaneous occurrence of B-cell lymphoma, cytolytic hepatitis, and lung carcinoma is rare.

Observation:

A 58-year-old man developed a skin-restricted B-cell lymphoma while on methotrexate for non-rheumatoid peripheral arthritis.
The patient also presented with concurrent cytolytic hepatitis and lung carcinoma.
The lymphoma and hepatitis resolved spontaneously within two weeks of discontinuing methotrexate.

Findings:

Immunoglobulin gene rearrangement confirmed the B-cell origin of the lymphoma.

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Polymerase chain reaction (PCR) detected immunoglobulin gene rearrangement.

In situ hybridization did not detect Epstein-Barr virus (EBV)-positive neoplastic cells, suggesting an EBV-negative lymphoma.

Implications:

This case suggests a potential link between methotrexate and the development of EBV-negative B-cell lymphoma.
Spontaneous regression of the lymphoma and hepatitis upon drug withdrawal indicates a drug-induced phenomenon.
Discontinuation of immunosuppressive therapy may lead to remission of certain drug-associated lymphoproliferative disorders.