CD8-positive T-cell lymphoproliferative disorder associated with Epstein-Barr virus-infected B-cells in a rheumatoid arthritis patient under methotrexate treatment

We report a 48-year-old female who developed lymphoproliferative disorder (LPD) during treatment of rheumatoid arthritis (RA) with methotrexate (MTX). She presented with multiple tumors in the cervical lymph nodes (LNs), multiple lung shadows and round shadows in both kidneys with pancytopenia and a...

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Bibliographic Details
Published inModern rheumatology Vol. 26; no. 2; pp. 271 - 275
Main Authors Koji, Hitoshi, Yazawa, Takuya, Nakabayashi, Kimimasa, Fujioka, Yasunori, Kamma, Hiroshi, Yamada, Akira
Format Journal Article
LanguageEnglish
Published United States Informa Healthcare 01.01.2016
Subjects
Arthritis, Rheumatoid - complications
Arthritis, Rheumatoid - drug therapy
Arthritis, Rheumatoid - pathology
B-Lymphocytes - pathology
B-Lymphocytes - virology
CD8-Positive T-Lymphocytes
Chemotherapy
Epstein-Barr virus
Epstein-Barr Virus Infections - complications
Epstein-Barr Virus Infections - pathology
Female
Herpesvirus 4, Human
Humans
Lymph Nodes - pathology
Lymphoproliferative Disorders - complications
Lymphoproliferative Disorders - pathology
Methotrexate - therapeutic use
Middle Aged
Rheumatoid arthritis
Rheumatology
T cell receptors
Tumors
Epstein-Barr virus
CD8-positive T-cell
Lymphoproliferative disorder
Methotrexate
Rheumatoid arthritis
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Summary:We report a 48-year-old female who developed lymphoproliferative disorder (LPD) during treatment of rheumatoid arthritis (RA) with methotrexate (MTX). She presented with multiple tumors in the cervical lymph nodes (LNs), multiple lung shadows and round shadows in both kidneys with pancytopenia and a high CRP level. The LN showed CD8-positive T-cell LPD associated with Epstein-Barr (EB) virus-infected B-cells. Clonality assays for immunoglobulin (Ig) heavy chain and T-cell receptor gamma (TCRγ) were negative. The cessation of MTX without chemotherapy resulted in the complete disappearance of the tumors and abnormal clinical features. We compared this case with previously published ones and discuss the pathological findings, presuming that the proliferation of CD8 T-cells was a reactive manifestation to reactivated EB virus-infected B-cells.
Bibliography:ObjectType-Case Study-2
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ISSN:1439-7595
1439-7609
DOI:10.3109/14397595.2013.850613