Journal
INTERNAL MEDICINE
Volume 57, Issue 14, Pages 2071-2075Publisher
JAPAN SOC INTERNAL MEDICINE
DOI: 10.2169/internalmedicine.0308-17
Keywords
rheumatoid arthritis; human T-lymphotropic virus type 1; adult T-cell leukemia/lymphoma; methotrexate-associated lymphoproliferative disorder
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Funding
- Japan Agency for Medical Research and Development
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The patient was a 74-year-old Japanese woman with rheumatoid arthritis (RA) who developed generalized lymphadenopathy with elevated levels of lactase dehydrogenase (LD), and soluble IL-2 receptor (sIL-2R). She was found to be positive for anti-human T-cell leukemia virus type 1 (HTLV-1) antibodies. Her symptoms and laboratory abnormalities spontaneously regressed after the cessation of methotrexate (MTX), suggesting that she had an MTX-associated lymphoproliferative disorder; however, her lymphadenopathy appeared again approximately 14 months later with LD and sIL-2R elevation. A histopathologieal analysis and Southern blotting of a lymph node biopsy specimen for HTLV-1 provirus supported the diagnosis of adult T-cell leukemia/lymphoma (ATL) (lymphoma type). These data confirmed that an HTLV-1 positive RA patient may develop ATL.
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