Lai Wei-Fu, Chin Yen-Po, Liu Chih-Wei, Tsai Chang-Youh
Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan.
Division of Allergy, Immunology & Rheumatology, Taipei Veterans General Hospital, Taipei, Taiwan.
BMJ Case Rep. 2017 Dec 1;2017:bcr-2017-221778. doi: 10.1136/bcr-2017-221778.
A 62-year-old woman with rheumatoid arthritis and secondary Sjögren's syndrome took methotrexate (MTX) 5 mg three times a week regularly but gradually developed an intermittent fever, oral ulcers and productive cough with mucopurulent sputum for about 2 weeks. Image study found multiple nodular lesions and lymphadenopathies in bilateral lungs. Empirical antibiotics for 1 week failed to alleviate the fever. A transbronchial biopsy in the right fourth bronchus showed infiltration of abnormally enlarged lymphoid cells with a surface marker of CD20, some of which also stained positively in situ with Epstein-Barr virus-encoded small RNA and some CD3(+) cells. After a diagnosis of MTX-associated lymphoproliferative disease had been made, MTX was discontinued immediately and intravenous methylprednisolone 125 mg/day was given for 1 week. The clinical condition improved dramatically within 1 month and there was no recurrence after 3-year follow-up.
一名62岁患有类风湿关节炎和继发性干燥综合征的女性，定期每周三次服用5毫克甲氨蝶呤（MTX），但逐渐出现间歇性发热、口腔溃疡以及伴有黏液脓性痰的咳痰症状，持续约2周。影像学检查发现双肺有多个结节性病变和淋巴结肿大。经验性使用抗生素1周未能缓解发热症状。右肺第四支气管的经支气管活检显示，有异常增大的、表面标记为CD20的淋巴细胞浸润，其中一些细胞还可原位被爱泼斯坦-巴尔病毒编码的小RNA染色，还有一些CD3(+)细胞。在诊断为甲氨蝶呤相关淋巴增殖性疾病后，立即停用甲氨蝶呤，并给予每日125毫克静脉注射甲基泼尼松龙，持续1周。1个月内临床状况显著改善，3年随访后无复发。
