A Clinical, Pathological, and Genetic Characterization of Methotrexate-associated Lymphoproliferative Disorders

Abstract

Our data demonstrate that patients in the EBVMCU, a specific clinical subgroup of MTX-LPD, had a better clinical outcome when MTX was withdrawn than did other patients with MTX-LPD.

Multiple Intestinal Ulcers Associated with Primary Epstein-Barr Virus Infection in a Patient with Rheumatoid Arthritis Undergoing Methotrexate Therapy

“…The pathognomonic histology of EBVMCU comprises of ulcers and polymorphous mixed lymphocytic infiltrates including atypical large B-cells and Reed-Sternberg-like cells uniformly expressing CD30 with EBER positivity, thus EBVMCU is considered as a clinical subtype of EBVassociated LPD (8). A recent study analyzing MTXassociated LPD (MTX-LPD) occurring in 20 patients with RA and 1 patient with polymyositis demonstrated that EB-VMCU was found in 24% of MTX-LPD and in 42% of EBV-positive MTX-LPD, indicating that EBVMCU constitutes a certain fraction of MTX-LPD (9). However, in the present case, atypical large B cells or CD30-positive ReedSternberg-like cells and other types of immunoblastic cells were not found in ulcerative lesion, suggesting a pathogenesis distinct from that of EBVMCU underlies the perforated ulcer formation in the ileum.…”

Methotrexate-induced CD30+ T-cell lymphoproliferative disorder of the oral cavity

“…The World Health Organization in 2008 defined a broad category of “posttransplantation and iatrogenic” LPDs that recognizes iatrogenic immunosuppression as a pathogenic factor, with MTX included as an etiologic agent of iatrogenic immunodeficiency-associated LPDs 2, 3, 4. The proposed mechanism by which this occurs is via MTX-induced suppression of EBV-specific cytotoxic T cells, which promotes the reactivation of EBV-specific B cells that proliferate 4 .…”

“…The proposed mechanism by which this occurs is via MTX-induced suppression of EBV-specific cytotoxic T cells, which promotes the reactivation of EBV-specific B cells that proliferate 4 . Although MTX-induced LPDs in RA patients have been discussed in previous case reports, lesions presenting on the skin and oral cavity were rarely reported in the literature 5, 6.…”

Methotrexate‐related lymphoproliferative disorder arising in the gingiva of a patient with rheumatoid arthritis

“…15 If Despite the advent of new effective biologic agents, MTX is still recommended as the most effective drug and as an anchor drug to enhance or maintain the efficacy of biologic agents. We should keep in mind the association between MTX and occurrences of oral LPDs.…”