Koji Hitoshi, Yazawa Takuya, Nakabayashi Kimimasa, Fujioka Yasunori, Kamma Hiroshi, Yamada Akira
a First Department of Internal Medicine , Kyorin University School of Medicine , Mitaka, Tokyo , Japan.
b Department of Pathology , Kyorin University School of Medicine , Mitaka, Tokyo , Japan.
Mod Rheumatol. 2016;26(2):271-5. doi: 10.3109/14397595.2013.850613. Epub 2014 Jan 3.
We report a 48-year-old female who developed lymphoproliferative disorder (LPD) during treatment of rheumatoid arthritis (RA) with methotrexate (MTX). She presented with multiple tumors in the cervical lymph nodes (LNs), multiple lung shadows and round shadows in both kidneys with pancytopenia and a high CRP level. The LN showed CD8-positive T-cell LPD associated with Epstein-Barr (EB) virus-infected B-cells. Clonality assays for immunoglobulin (Ig) heavy chain and T-cell receptor gamma (TCRγ) were negative. The cessation of MTX without chemotherapy resulted in the complete disappearance of the tumors and abnormal clinical features. We compared this case with previously published ones and discuss the pathological findings, presuming that the proliferation of CD8 T-cells was a reactive manifestation to reactivated EB virus-infected B-cells.
我们报告了一名48岁女性，她在使用甲氨蝶呤（MTX）治疗类风湿关节炎（RA）期间发生了淋巴增殖性疾病（LPD）。她出现颈部淋巴结（LN）多发肿瘤、双肺多发阴影以及双肾圆形阴影，伴有全血细胞减少和高CRP水平。淋巴结显示为与爱泼斯坦-巴尔（EB）病毒感染的B细胞相关的CD8阳性T细胞LPD。免疫球蛋白（Ig）重链和T细胞受体γ（TCRγ）的克隆性检测为阴性。停用MTX且未进行化疗后，肿瘤和异常临床特征完全消失。我们将该病例与先前发表的病例进行了比较，并讨论了病理结果，推测CD8 T细胞的增殖是对重新激活的EB病毒感染B细胞的一种反应性表现。
