A Case of Methotrexate-associated Lymphoproliferative Disorder Developed as Diffuse Large B Cell Lymphoma on the Lower Leg with Reactivated Epstein-Barr Virus

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  • MURAYAMA Naoya
    Department of Dermatology, Graduate School of Biomedical Sciences, Nagasaki University
  • KOIKE Yuta
    Department of Dermatology, Graduate School of Biomedical Sciences, Nagasaki University
  • TASAKI Noriko
    Department of Dermatology, Graduate School of Biomedical Sciences, Nagasaki University
  • KUWATSUKA Yutaka
    Department of Dermatology, Graduate School of Biomedical Sciences, Nagasaki University
  • TOMIMURA Saori
    Department of Dermatology, Graduate School of Biomedical Sciences, Nagasaki University
  • TAKENAKA Motoi
    Department of Dermatology, Graduate School of Biomedical Sciences, Nagasaki University
  • UTANI Atsushi
    Department of Dermatology, Graduate School of Biomedical Sciences, Nagasaki University

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Other Title
  • 下肢に Diffuse Large B-cell Lymphoma を生じ，Epstein-Barr Virus 再活性化の関与が疑われたメトトレキサート関連リンパ増殖性疾患の 1 例
  • 症例 下肢にDiffuse Large B-cell Lymphomaを生じ,Epstein-Barr Virus再活性化の関与が疑われたメトトレキサート関連リンパ増殖性疾患の1例
  • ショウレイ カシ ニ Diffuse Large B-cell Lymphoma オ ショウジ,Epstein-Barr Virus サイカッセイカ ノ カンヨ ガ ウタガワレタ メトトレキサート カンレン リンパ ゾウショクセイ シッカン ノ 1レイ

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Abstract

<p>We report a case of 76-year-old female patient with rheumatoid arthritis, who presented diffuse large B cell lymphoma (DLBCL) developed on the lower leg. Previously, she had been administrated immunosuppressive treatment with methotrexate (MTX) (8 mg/week) and prednisolone (7. 5 mg/day) for 5 years. Physical examination showed sporadic erythema and nodules on the both lower legs, respectively. Topical therapies failed to treat those lesions. After that, the lesions formed a tumor on the left lower leg and formed ulcers on the right lower leg. Histological examination of the left lower leg showed large sized atypical lymphocytes with CD20-positive proliferated in the entire dermis, which demonstrated the diagnosis with DLBCL. In addition, Epstein-Barr virus (EBV) infection in the tumor cells were confirmed by EBV-encoded small RNA and EBV-latent membrane protein 1. On one hand, histological examination of the right lower leg showed oligoclonal proliferating T cells in the superficial dermis. After withdrawal of MTX therapy, the tumor rapidly regressed without chemotherapy. We diagnosed MTX-associated lymphoproliferative disorder (MTX-LPD) appeared as DLBCL due to the histopathological findings and the characteristic clinical course. When we examine a patient under treatment with MTX,we have to keep in mind that there is more risk of MTX-LPD which may induce malignant lymphoma.</p>

Journal

  • Nishi Nihon Hifuka

    Nishi Nihon Hifuka 80 (3), 214-218, 2018-06-01

    Western Division of Japanese Dermatological Association

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