A Case of Methotrexate-associated Lymphoproliferative Disorder with Multiple Nodules in the Lung and Bronchus

DOI 2 Citations
  • Torii Ryo
    Department of Respiratory Medicine, Wakamatsu Hospital of the University of Occupational and Environmental Health
  • Noguchi Shingo
    Department of Respiratory Medicine, Wakamatsu Hospital of the University of Occupational and Environmental Health
  • Shimabukuro Ikuko
    Department of Respiratory Medicine, Wakamatsu Hospital of the University of Occupational and Environmental Health
  • Yoshii Chiharu
    Department of Respiratory Medicine, Wakamatsu Hospital of the University of Occupational and Environmental Health
  • Yatera Kazuhiro
    Department of Respiratory Medicine, University of Occupational and Environmental Health

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  • 肺および気管内に多発する病変を認めたメトトレキサート関連リンパ増殖性疾患の1例

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<p>Background. Although some cases of methotrexate (MTX)-associated lymphoproliferative disorder (LPD) have been reported, cases of MTX-LPD with pulmonary nodules are less common. In addition, cases in which bronchial nodules due to MTX-associated with LPD directly observed by bronchoscopy are extremely rare. Case. A 73-year-old woman with rheumatoid arthritis (RA) had been treated with MTX and salazosulfapyridine since June 2011. She was admitted due to sore throat and a right enlarged tonsil in November 2014 and MTX-LPD was suspected. MTX therapy for RA was therefore discontinued and her sore throat improved. However, the symptom relapsed in February 2015. Chest computed tomography (CT) in June of the same year showed multiple nodular shadows in bilateral lungs, and demonstrated the augmentation of the shadows. Therefore, she was introduced to our department and underwent bronchoscopy. The lung and bronchial biopsy findings were consistent with diffuse large B-cell lymphoma (DLBCL), and we diagnosed MTX-LPD based on the clinical course. Conclusions. Physicians should be aware of possible MTX-LPD when multiple nodules are observed in lungs and bronchi in patients with RA with MTX treatment.</p>

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