Fujimoto Masakazu, Kaku Yo, Yamakawa Noriyuki, Kawabata Daisuke, Ohmura Koichiro, Koyanagi Itsuko, Mimori Tsuneyo, Kabashima Kenji, Haga Hironori
Department of Diagnostic Pathology, Kyoto University Hospital, Kyoto, Japan.
Department of Dermatology, Kyoto University Hospital, Kyoto, Japan.
J Cutan Pathol. 2016 Jun;43(6):520-525. doi: 10.1111/cup.12690. Epub 2016 Apr 18.
Rheumatoid vasculitis (RV) is one of the most serious extra-articular complications of rheumatoid arthritis (RA), generally treated with a high dose of immunosuppressive drugs. Recently, we encountered two cases of ulcerative vasculitis in methotrexate (MTX)-prescribed RA patients, which simulated RV; however, Epstein-Barr virus (EBV)-encoded RNA in situ hybridization on their skin biopsies revealed many EBV-positive lymphocytes (over 50 cells/high-power field) within the vessel walls and perivascular stroma, which led us to the diagnosis of EBV-related vasculitis instead of RV. Subsequently, both ulcers regressed after the discontinuation of MTX and no recurrence was noted during the follow-up period. To prevent unnecessary treatment, EBV-positive vasculitis should be added in the differential diagnosis of lymphocytic vasculitis observed in MTX-administered RA patients.
类风湿性血管炎（RV）是类风湿性关节炎（RA）最严重的关节外并发症之一，通常采用高剂量免疫抑制药物治疗。最近，我们遇到两例在服用甲氨蝶呤（MTX）的RA患者中发生的溃疡性血管炎病例，这些病例酷似RV；然而，对其皮肤活检进行的爱泼斯坦-巴尔病毒（EBV）编码RNA原位杂交显示，血管壁和血管周围基质中有许多EBV阳性淋巴细胞（每高倍视野超过50个细胞），这使我们诊断为EBV相关血管炎而非RV。随后，停用MTX后两个溃疡均消退，随访期间未观察到复发。为避免不必要的治疗，在MTX治疗的RA患者中观察到的淋巴细胞性血管炎的鉴别诊断中应加入EBV阳性血管炎。
