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一例甲氨蝶呤相关性淋巴增生性疾病,在一名类风湿关节炎患者中表现为多发肝脏病变。

A case of methotrexate-related lymphoproliferative disease showing multiple liver lesions in a patient with rheumatoid arthritis.

机构信息

Department of Gastroenterology, Yamagata Prefectural Shinjo Hospital, 720-1 Kanazawa, Shinjo, Yamagata, 996-8585, Japan.

Department of Pathology, Faculty of Medicine, Yamagata University, Yamagata, Japan.

出版信息

Clin J Gastroenterol. 2024 Aug;17(4):705-710. doi: 10.1007/s12328-024-01963-6. Epub 2024 Apr 20.

Abstract

A 66-year-old woman with rheumatoid arthritis (RA) who had been receiving methotrexate (MTX) for 2 years presented with tarry stools. Contrast-enhanced computed tomography (CT) of the abdomen revealed irregular wall thickening in the ileocecal region and multiple low-contrast masses in both lobes of the liver. Lower gastrointestinal endoscopy revealed a type 2 tumor in the ileocecal region with a semi-peripheral ulcer. Histological examination of liver and colon biopsies showed other iatrogenic immunodeficiency-associated lymphoproliferative disorder (Oi-LPD), diffuse large B-cell lymphoma type, with positivity for Epstein-Barr virus DNA. After withdrawal of MTX, the LPD lesions disappeared and the patient achieved remission. We considered this to be a sporadic case of Oi-LPD, diffuse large B-cell lymphoma type, in the liver and colon due to treatment with MTX. There has been no previous report of this condition with simultaneous hepatic and colonic lesions, and the present case is thought to be highly informative in relation to the pathogenesis.

摘要

一位 66 岁女性,类风湿关节炎(RA)患者,接受甲氨蝶呤(MTX)治疗 2 年,出现柏油样便。腹部增强 CT 显示回盲部不规则肠壁增厚和肝两叶多发低对比肿块。下消化道内镜显示回盲部 2 型肿瘤,伴半周形溃疡。肝和结肠活检的组织学检查显示其他医源性免疫缺陷相关淋巴组织增生性疾病(Oi-LPD),弥漫性大 B 细胞淋巴瘤型,EBV-DNA 阳性。停用 MTX 后,LPD 病变消失,患者缓解。我们考虑这是一例 MTX 治疗引起的散发性 Oi-LPD,弥漫性大 B 细胞淋巴瘤型,肝和结肠同时受累。此前尚无同时累及肝和结肠的此类病变的报道,本例对发病机制具有重要提示意义。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4a96/11284183/c5a61412c6db/12328_2024_1963_Fig1_HTML.jpg

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