A Case of Other Iatrogenic Immunodeficiency-associated Lymphoproliferative Disorders Induced by Methotrexate with Extensive Tracheobronchial Involvement

• Published in: The Journal of the Japan Society for Respiratory Endoscopy Vol. 44; no. 4; pp. 305 - 312
• Main Authors: Inada, Yuya, Itoh, Tomoyoshi, Iwasaki, Kohei, Furukawa, Yuichiro, Mizutani, Ryo, Shinoki, Masato, Akagi, Kanako, Sakurai, Takaki, Kawaguchi, Tomoya
• Format: Journal Article
• Language: Japanese
• Published: The Japan Society for Respiratory Endoscopy 25.07.2022
• Subjects: Endobronchial biopsy (EBB); Methotrexate-associated lymphoproliferative disorders (MTX-LPD); Other iatrogenic immunodeficiency-associated lymphoproliferative disorders (OIIA-LPD); Rheumatoid arthritis; Tracheobronchial tumor
• ISSN: 0287-2137; 2186-0149
• DOI: 10.18907/jjsre.44.4_305

Background. Other iatrogenic immunodeficiency-associated lymphoproliferative disorders (OIIA-LPD) are caused by immunosuppressive agents such as methotrexate (MTX). We report a rare case of MTX-induced OIIA-LPD with extensive tracheal and bronchial lesions diagnosed based on endobronchial biopsy (EBB). Case. The patient was a 75-year-old woman who was diagnosed with rheumatoid arthritis 15 years previously, and MTX treatment was initiated at the time of the diagnosis. One year prior to her current presentation, computed tomography (CT) revealed a mass shadow in the left lower lobe of the chest, which gradually increased in size; thus, bronchoscopy was performed. Endoscopic findings revealed multiple elevated lesions in the trachea and bronchi, which could not be detected using CT. Pathological EBB findings indicated lymphoproliferative disorders (LPD). Two months after the discontinuation of MTX, endoscopic findings revealed shrinkage of the tracheal mass and a mass shadow in the left lower lobe, which led to the diagnosis of MTX-induced OIIA-LPD. Conclusion. When a mass shadow appears in the lung field during long-term MTX treatment and MTX-induced OIIA-LPD is suspected, bronchoscopy is essential for determining the presence of extensive airway lesions. EBB of airway lesions is considered important for the diagnosis of MTX-induced OIIA-LPD.