Kato Takeharu, Imaizumi Yoshitaka, Itonaga Hidehiro, Sato Shinya, Ando Koji, Sawayama Yasushi, Ichinose Kunihiro, Miyoshi Hiroaki, Ohshima Koichi, Miyazaki Yasushi
Department of Hematology, Nagasaki University Hospital.
Department of Rheumatology, Nagasaki University Hospital.
Rinsho Ketsueki. 2023;64(2):97-101. doi: 10.11406/rinketsu.64.97.
A 55-year old female patient was treated with methotrexate (MTX) and infliximab (IFX) for rheumatoid arthritis (RA). She experienced unknown fever, generalized lymphadenopathy, and liver tumors. Histological examination of the inguinal lymph node and a liver tumor resulted in the pathological diagnosis of classic Hodgkin lymphoma, with many Reed-Sternberg cells with the positivity of Epstein-Barr virus (EBV). She was diagnosed with MTX-related lymphoproliferative disorders (MTX-LPDs). She received chemotherapy after the cessation of MTX and IFX and achieved complete remission. RA showed recurrence after a while, and she was treated with steroids or other drugs. Six years after the chemotherapy, she experienced low-grade fever and anorexia. Whole computed tomography images showed an appendix tumor and enlargement of the surrounding lymph nodes. Appendectomy with the radical lymph nodes dissection was performed. The pathological diagnosis was diffuse large B-cell lymphoma, resulting in the clinical diagnosis of the relapse of MTX-LPD. EBV was negative at this point. The pathological findings of MTX-LPD may change at relapse; thus, biopsy should be considered when the relapse of MTX-LPD is suggested.
一名55岁女性患者因类风湿关节炎（RA）接受甲氨蝶呤（MTX）和英夫利昔单抗（IFX）治疗。她出现不明原因发热、全身淋巴结肿大和肝脏肿瘤。腹股沟淋巴结和肝脏肿瘤的组织学检查结果为经典型霍奇金淋巴瘤的病理诊断，有许多里德-施特恩伯格细胞且爱泼斯坦-巴尔病毒（EBV）呈阳性。她被诊断为MTX相关淋巴增殖性疾病（MTX-LPDs）。在停用MTX和IFX后她接受了化疗并实现完全缓解。一段时间后RA复发，她接受了类固醇或其他药物治疗。化疗6年后，她出现低热和厌食。全腹部计算机断层扫描图像显示阑尾肿瘤及周围淋巴结肿大。进行了阑尾切除术及根治性淋巴结清扫术。病理诊断为弥漫性大B细胞淋巴瘤，临床诊断为MTX-LPD复发。此时EBV为阴性。MTX-LPD复发时病理表现可能改变；因此，当提示MTX-LPD复发时应考虑活检。
