Sakaguchi Ryuki, Fujikawa Keita, Okamoto Momoko, Matsuo Emi, Matsumoto Kohei, Uchida Tomohisa, Shin-Ya Kawashiri, Nakashima Masahiro, Mizokami Akinari, Kawakami Atsushi
Department of Rheumatology, Japan Community Healthcare Organization, Isahaya General Hospital, Japan.
Department of Hematology, Japan Community Healthcare Organization, Isahaya General Hospital, Japan.
Intern Med. 2019 Nov 1;58(21):3167-3171. doi: 10.2169/internalmedicine.2995-19. Epub 2019 Jul 10.
A 44-year-old female with rheumatoid arthritis treated with methotrexate (MTX) and tocilizumab (TCZ) was admitted to our hospital with nasal pain. Nasal fiberscopy revealed septum perforation, while a membrane biopsy indicated granuloma and fibrinoid necrosis of the small artery. The patient was treated with prednisolone 30 mg/day after discontinuation of MTX and TCZ. Inguinal lymph node biopsy revealed diffuse infiltrations of atypical T-cells and Epstein-Barr virus-positive B cells. The patient was diagnosed with peripheral T-cell lymphoma due to MTX-associated lymphoproliferative disorder (MTX-LPD). We herein describe the case of a patient with nasal septum perforation due to MTX-LPD mimicking granulomatosis with polyangiitis.
一名44岁类风湿关节炎女性患者，接受甲氨蝶呤（MTX）和托珠单抗（TCZ）治疗，因鼻痛入院。鼻纤维镜检查显示鼻中隔穿孔，而膜活检提示小动脉肉芽肿和纤维素样坏死。停用MTX和TCZ后，患者接受泼尼松龙30mg/天治疗。腹股沟淋巴结活检显示非典型T细胞和爱泼斯坦-巴尔病毒阳性B细胞弥漫浸润。该患者因MTX相关淋巴增殖性疾病（MTX-LPD）被诊断为外周T细胞淋巴瘤。我们在此描述一例因MTX-LPD模仿肉芽肿性多血管炎而导致鼻中隔穿孔的患者病例。
