Quaye Elizabeth H, D'Angelis Christopher, Powell Jennifer
Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA VA Western New York Healthcare System, Buffalo, New York, USA.
Dermatol Online J. 2023 Feb 15;29(1). doi: 10.5070/D329160212.
Methotrexate (MTX) is a first-line systemic medication used to treat rheumatoid arthritis because of its immunomodulatory effects. However, MTX has also been linked to the development of lymphoproliferative disorders (LPD) in patients with rheumatoid arthritis. We describe a patient with long-standing rheumatoid arthritis treated with MTX who developed cutaneous Epstein-Barr virus (EBV)-positive B cell lymphoproliferative disease resembling grade III lymphomatoid granulomatosis localized to the right leg. The lymphomatoid process resolved with withdrawal of the MTX. The pathogenesis of iatrogenic lymphoproliferative disorder was most likely triggered by the rheumatoid inflammation and the immunosuppressing effects of MTX, which led to EBV reactivation. We recommend a trial of MTX discontinuation prior to considering chemotherapy in patients with rheumatoid arthritis treated with MTX who develop EBV-positive B cell lymphoproliferative disease resembling a high grade B-cell lymphoma.
甲氨蝶呤（MTX）是一种用于治疗类风湿关节炎的一线全身性药物，因其具有免疫调节作用。然而，MTX也与类风湿关节炎患者发生淋巴增殖性疾病（LPD）有关。我们描述了一名长期患有类风湿关节炎且接受MTX治疗的患者，该患者发生了皮肤爱泼斯坦-巴尔病毒（EBV）阳性B细胞淋巴增殖性疾病，类似于局限于右腿的III级淋巴瘤样肉芽肿病。停用MTX后，淋巴瘤样病变消退。医源性淋巴增殖性疾病的发病机制很可能是由类风湿炎症和MTX的免疫抑制作用触发的，这导致了EBV的重新激活。对于接受MTX治疗且发生类似于高级别B细胞淋巴瘤的EBV阳性B细胞淋巴增殖性疾病的类风湿关节炎患者，我们建议在考虑化疗之前先尝试停用MTX。
