Khopkar Uday, Bhor Urmila
Department of Dermatology, Seth GS Medical college and KEM Hospital, Parel, Mumbai, India.
Indian J Dermatol Venereol Leprol. 2008 Jul-Aug;74(4):379-82. doi: 10.4103/0378-6323.42919.
Methotrexate (MTX) is used in the treatment of a variety of diseases such as rheumatoid arthritis, dermatomyositis, juvenile rheumatoid arthritis and chronic plaque psoriasis. It has been well documented that there is a risk of development of lymphomas in these patients although none have been reported in patients of psoriasis treated with methotrexate. A 58-year-old male patient, a known case of psoriasis since 1994, had been receiving treatment with a low dose of MTX, 5 mg weekly for ten years intermittently (7-8 months/year). The cumulative dose of MTX taken was 1.5 gm. He developed high-grade fever with cervical lymphadenopathy that was nonresponsive to routine line of management. Lymph node biopsy revealed the presence of mixed cellularity type of Hodgkin's lymphoma. CT scan showed cervical, mediastinal and abdominal lymphadenopathy. The patient responded well to withdrawal of MTX and chemotherapy. This is the first case of lymphoma occurring in a patient of psoriasis treated with low-dose MTX.
甲氨蝶呤（MTX）用于治疗多种疾病，如类风湿性关节炎、皮肌炎、青少年类风湿性关节炎和慢性斑块状银屑病。已有充分文献证明，这些患者有发生淋巴瘤的风险，尽管在用甲氨蝶呤治疗的银屑病患者中尚未有病例报告。一名58岁男性患者，自1994年起即为银屑病患者，间断接受小剂量MTX治疗，每周5毫克，持续十年（每年7 - 8个月）。MTX累计服用剂量为1.5克。他出现高热伴颈部淋巴结肿大，对常规治疗无反应。淋巴结活检显示为混合细胞型霍奇金淋巴瘤。CT扫描显示颈部、纵隔和腹部淋巴结肿大。患者停用MTX并接受化疗后反应良好。这是首例在用小剂量MTX治疗的银屑病患者中发生淋巴瘤的病例。
