期刊
AMERICAN JOURNAL OF THE MEDICAL SCIENCES
卷 338, 期 4, 页码 334-335出版社
ELSEVIER SCIENCE INC
DOI: 10.1097/MAJ.0b013e3181acbb49
关键词
Epstein-Barr virus; Lymphoproliferative disorder; Methotrexate; Rheumatoid arthritis; Spontaneous remission
A 73-year-old woman with rheumatoid arthritis had been treated with weekly low-dose methotrexate (MTX) for 5 years. She Suffered from epigastric discomfort. Endoscopic examination revealed a tumor resembling advanced gastric cancer. Biopsy specimens showed atypical lymphoid cell infiltration. Immunohistological studies showed that these cells were positive for CD30 and CD79a, but not for CD15 or CD20. In situ hybridization identified Epstein-Barr virus latency-associated RNA expression in these cells. Clonally rearranged immunoglobulin heavy chain JH gene was not detected by Southern blot analysis. She was diagnosed with Epstein-Barr virus-associated polymorphic lymphoproliferative disorder (LPD) due to immunodeficiency caused by MTX administration. Cessation of MTX therapy led to complete regression of the tumor. To our knowledge, this is the first case of spontaneous remission of MTX-associated gastric LPD after discontinuation of MTX therapy. Increased awareness is needed oil the possible occurrence of LPD resembling gastric cancer in rheumatoid arthritis patients treated with MTX.
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