Title |
Primary central nervous system lymphoma in a rheumatoid arthritis patient treated with methotrexate: a case report
|
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Published in |
BMC Research Notes, March 2015
|
DOI | 10.1186/s13104-015-1040-0 |
Pubmed ID | |
Authors |
Hiromi Shimada, Hiroaki Dobashi, Hisanori Morimoto, Tomohiro Kameda, Kentaro Susaki, Miharu Izumikawa, Yohei Takeuchi, Shusaku Nakashima, Osamu Imataki, Shuji Bandoh |
Abstract |
Rheumatoid arthritis is a systemic inflammatory disease characterized by synovitis and the destruction of articular structures in multiple joints. Methotrexate is recommended as an anchor drug for rheumatoid arthritis treatment to achieve the therapeutic goal of reducing damage to joints and improving clinical score. However, several studies have shown that methotrexate has been associated with the development of lymphoproliferative disorders, namely methotrexate-associated lymphoproliferative disorders. On the other hand, primary central nervous system lymphoma is an aggressive disease with poor prognosis. Both methotrexate-associated lymphoproliferative disorders and primary central nervous system lymphoma are reported to be associated with Epstein-Barr virus. A Japanese female patient of between 60 and 70 years of age with rheumatoid arthritis was admitted to our hospital because of sudden convulsion and impaired consciousness. Just before admission, she was treated with adalimumab and methotrexate. Contrast-enhanced computed tomography scan showed a densely stained mass with surrounding edema in both frontal lobes and the left nucleus basalis, and enlarged lymph nodes in the right supraclavicular fossa. We performed a biopsy of the right cervical lymph node, but could not establish a histopathological diagnosis. In situ hybridization showed the presence of Epstein Barr virus, therefore we diagnosed this case as methotrexate-associated lymphoproliferative disorders mediated by Epstein Barr virus after considering the drug history of the patient. After we discontinued methotrexate, patient symptoms gradually improved. The masses at both frontal lobes and the left nucleus basalis were gradually regressed. Since the frequency of methotrexate use and the maximum dosage has been increasing, particular attention should be paid to the development of methotrexate-associated lymphoproliferative disorders in rheumatoid arthritis patients who are treated with methotrexate. |
Mendeley readers
Geographical breakdown
Country | Count | As % |
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Unknown | 20 | 100% |
Demographic breakdown
Readers by professional status | Count | As % |
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Other | 4 | 20% |
Researcher | 3 | 15% |
Student > Ph. D. Student | 3 | 15% |
Student > Master | 2 | 10% |
Student > Bachelor | 2 | 10% |
Other | 3 | 15% |
Unknown | 3 | 15% |
Readers by discipline | Count | As % |
---|---|---|
Medicine and Dentistry | 8 | 40% |
Biochemistry, Genetics and Molecular Biology | 2 | 10% |
Pharmacology, Toxicology and Pharmaceutical Science | 1 | 5% |
Agricultural and Biological Sciences | 1 | 5% |
Nursing and Health Professions | 1 | 5% |
Other | 2 | 10% |
Unknown | 5 | 25% |