Kameda Hideto, Okuyama Ayumi, Tamaru Jun-Ichi, Itoyama Shinji, Iizuka Atsushi, Takeuchi Tsutomu
Division of Rheumatology/Clinical Immunology, Department of Internal Medicine, Saitama Medical Center, Saitama Medical University, 1981 Tsujido-machi, Kamoda, Kawagoe, Saitama 350-8550, Japan.
Clin Rheumatol. 2007 Sep;26(9):1585-9. doi: 10.1007/s10067-006-0480-2. Epub 2007 Jan 3.
We report on a patient of rheumatoid arthritis (RA) who sequentially developed an axillary mass and a fatal interstitial pneumonia during a 2-year course of methotrexate (MTX) therapy. Autopsy revealed a systemic lymph node involvement and the diagnosis of Epstein-Barr virus (EBV)-related lymphoproliferative disease (LPD) with the features of lymphomatoid granulomatosis was made. The lung tissue specimens revealed a typical diffuse alveolar damage (DAD), and small nodules consisting of atypical B lymphocytes showing positive staining for EBV were sparsely recognized only in basal lungs. This is the first report of a RA patient receiving MTX therapy sequentially developing MTX-associated lymphomatoid granulomatosis and DAD.
我们报告了一名类风湿关节炎（RA）患者，该患者在甲氨蝶呤（MTX）治疗的2年病程中先后出现腋窝肿块和致命的间质性肺炎。尸检显示全身淋巴结受累，并诊断为具有淋巴瘤样肉芽肿特征的爱泼斯坦-巴尔病毒（EBV）相关淋巴增殖性疾病（LPD）。肺组织标本显示典型的弥漫性肺泡损伤（DAD），仅在肺底部稀疏地发现由EBV阳性染色的非典型B淋巴细胞组成的小结节。这是首例接受MTX治疗的RA患者先后发生MTX相关淋巴瘤样肉芽肿和DAD的报告。
