Department of Medicine, Chiba-Nishi General Hospital, Chiba, Japan.
Department of Pathology, Chiba-Nishi General Hospital, Chiba, Japan.
Immunol Med. 2023 Dec;46(4):191-195. doi: 10.1080/25785826.2023.2212808. Epub 2023 May 18.
A 56-year-old woman was treated for rheumatoid arthritis for 17 years with methotrexate (MTX). Night sweats, fever and weight loss made her visit our hospital. Although levofloxacin failed to resolve her fever, she was suspected of having sepsis because of pancytopenia, elevated procalcitonin and a nodular lesion in the lung. After urgent hospitalization, she was diagnosed finally with the methotrexate-related lymphoproliferative disorder (MTX-LPD) associated with macrophage activation syndrome (MAS). Her general condition was improved with MTX withdrawal and 5-day high-dose glucocorticoid administration. Thus, even when the patient was critically ill with MAS, no cytotoxic agents were required to control MTX-LPD.
一位 56 岁女性因类风湿关节炎接受甲氨蝶呤（MTX）治疗 17 年。盗汗、发热和体重减轻导致她来我院就诊。尽管左氧氟沙星未能缓解其发热，但由于全血细胞减少、降钙素原升高和肺部结节性病变，她被怀疑患有脓毒症。紧急住院后，她最终被诊断为与巨噬细胞活化综合征（MAS）相关的甲氨蝶呤相关性淋巴增生性疾病（MTX-LPD）。停用 MTX 和 5 天大剂量糖皮质激素治疗后，她的一般情况得到改善。因此，即使患者患有 MAS 危象，也无需细胞毒性药物来控制 MTX-LPD。
