Hashimoto Kengo, Nagao Toru, Saito Terumi, Kinoshita Hiroyuki
Department of Oral and Maxillofacial Surgery and Stomatology, Okazaki City Hospital, Okazaki, Aichi, Japan.
Department of Oral and Maxillofacial Surgery and Stomatology, Okazaki City Hospital, Okazaki, Aichi, Japan.
Oral Surg Oral Med Oral Pathol Oral Radiol. 2015 Jan;119(1):e1-5. doi: 10.1016/j.oooo.2014.04.002. Epub 2014 Apr 18.
Incidences of lymphoproliferative disorders (LPDs) in patients with compromised immune systems associated with immunosuppressants such as methotrexate (MTX) administered for the treatment of rheumatoid arthritis (RA) are reportedly increasing. Although extranodal lesions develop in half of the patients with MTX-associated LPDs, only a few studies have reported on intraoral lesions. We evaluated 2 elderly women with MTX-associated LPDs who had received MTX for the treatment of RA and presented with atypical ulceration of the tongue. Biopsy specimens demonstrated polymorphous B-cell LPD, probably associated with MTX. Epstein-Barr virus (EBV) was identified by immunohistochemistry for latent membrane protein 1 and by EBV-encoded RNA in situ hybridization. After MTX withdrawal, in both cases, ulcers showed complete regression at 8 weeks, and no subsequent treatment was required. Close monitoring of LPDs is mandatory, because recurrence within 10 months has been reported in half of the patients in whom LPDs had initially regressed.
据报道，在因使用甲氨蝶呤（MTX）等免疫抑制剂治疗类风湿性关节炎（RA）而导致免疫系统受损的患者中，淋巴增殖性疾病（LPDs）的发病率正在上升。尽管在一半的MTX相关LPDs患者中会出现结外病变，但仅有少数研究报道过口腔内病变。我们评估了2名患有MTX相关LPDs的老年女性，她们因治疗RA而接受MTX治疗，并出现了舌部非典型溃疡。活检标本显示为多形性B细胞LPD，可能与MTX有关。通过免疫组织化学检测潜伏膜蛋白1以及EBV编码RNA原位杂交鉴定出爱泼斯坦-巴尔病毒（EBV）。停用MTX后，在这两个病例中，溃疡在8周时完全消退，无需后续治疗。由于据报道，在LPDs最初消退的患者中，有一半会在10个月内复发，因此对LPDs进行密切监测是必不可少的。
