Methotrexate related B lymphoproliferative disease in a patient with rheumatoid arthritis. Role of Epstein-Barr virus infection

A 57-year-old woman receiving low dose methotrexate (MTX) for rheumatoid arthritis (RA) developed a B lymphoproliferative disease (LPD) that was initially considered as large cell non-Hodgkin's lymphoma of B cell phenotype. Epstein-Barr virus (EBV) cytotoxic latent membrane protein-1 (LMP-1) ex...

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Bibliographic Details
Published inJournal of rheumatology Vol. 22; no. 6; p. 1174
Main Authors Lioté, F, Pertuiset, E, Cochand-Priollet, B, D'Agay, M F, Dombret, H, Numéric, P, D'Anglejan, G, Kuntz, D
Format Journal Article
LanguageEnglish
Published Canada 01.06.1995
Subjects
Arthritis, Rheumatoid - drug therapy
Arthritis, Rheumatoid - virology
B-Lymphocytes - pathology
Burkitt Lymphoma
Female
Herpesvirus 4, Human
Humans
Lymph Nodes - pathology
Lymphoproliferative Disorders - chemically induced
Lymphoproliferative Disorders - metabolism
Lymphoproliferative Disorders - pathology
Methotrexate - adverse effects
Methotrexate - therapeutic use
Middle Aged
Viral Matrix Proteins - metabolism
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Summary:A 57-year-old woman receiving low dose methotrexate (MTX) for rheumatoid arthritis (RA) developed a B lymphoproliferative disease (LPD) that was initially considered as large cell non-Hodgkin's lymphoma of B cell phenotype. Epstein-Barr virus (EBV) cytotoxic latent membrane protein-1 (LMP-1) expression was found in some large cells. The lymphoproliferative disease reversed with MTX discontinuation and without chemotherapy. These EBV-associated LPD in patients with RA receiving MTX or other immunosuppressive agents seem to be similar to those triggered by EBV in transplant patients receiving cyclosporine A. MTX withdrawal and short followup should be considered before chemotherapy since spontaneous regression is possible.
ISSN:0315-162X