A Case of Methotrexate-Associated Lymphoproliferative Disease with a Chief Complaint of Facial Pain

DOI
  • Asano Takahiro
    Department of Dentistry and Oral Surgery, Kawasaki Municipal Ida Hospital Department of Dentistry and Oral Surgery, Keio University School of Medicine
  • Yajima Shosuke
    Department of Dentistry and Oral Surgery, Kawasaki Municipal Ida Hospital Department of Dentistry and Oral Surgery, Keio University School of Medicine
  • Yasui Mariko
    Department of Dentistry and Oral Surgery, Keio University School of Medicine
  • Ochiai Shunsuke
    Department of Dentistry and Oral Surgery, Keio University School of Medicine
  • Endo Tomoki
    Department of Dentistry and Oral Surgery, Keio University School of Medicine
  • Yoshikawa Momoko
    Department of Dentistry and Oral Surgery, Keio University School of Medicine Department of Dentistry and Oral Surgery, National Hospital Organization, Murayama Medical Center
  • Saisu Hironori
    Pain Center, Aichi Medical University
  • Sato Hitoshi
    Department of Oral and Maxillofacial Surgery, Division of Oral Oncology, School of Dentistry, Showa University
  • Ouchi Takehito
    Department of Dentistry and Oral Surgery, Keio University School of Medicine
  • Asoda Seiji
    Department of Dentistry and Oral Surgery, Keio University School of Medicine
  • Usuda Sho
    Department of Dentistry and Oral Surgery, Keio University School of Medicine
  • Nakagawa Taneaki
    Department of Dentistry and Oral Surgery, Keio University School of Medicine
  • Muraoka Wataru
    Department of Dentistry and Oral Surgery, Kawasaki Municipal Ida Hospital Department of Dentistry and Oral Surgery, Keio University School of Medicine

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Other Title
  • 顔面痛を主訴に来院し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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Abstract

Case summary: We report a case of methotrexate-associated lymphoproliferative disease （MTX-LPD） in a 69-year-old woman with rheumatoid arthritis （RA） and Sjögren’s syndrome （SjS） who presented to our department with a complaint of left facial pain. The patient was diagnosed with RA 17 years ago and had been using methotrexate （MTX） and prednisolone for a long time. She also had frequent swelling of the parotid gland due to SjS. The patient had bullae under the left nasal wing and mild swelling of the parotid gland. We diagnosed herpes zoster of the second branch of the left trigeminal nerve and left parotitis caused by SjS, and started the initial treatment. However, neoplastic lesions in the parotid region were suspected, and biopsy results confirmed the diagnosis of MTX-LPD.<br>Discussion: It is common knowledge that RA and MTX administration are risk factors for the development of stomatitis and herpes zoster. In this case, a patient with repeated swelling of the parotid gland due to SjS came to our hospital with left facial pain, and not only herpes zoster as an acute symptom but also MTX-LPD in the parotid gland area contributed to the difficulty in differential diagnosis.<br>Conclusion: Patients with autoimmune diseases such as RA and SjS routinely visit dental clinic and oral surgeons, and they often use immunosuppressive drugs such as MTX. When they experience pain in the orofacial region, the condition may be complicated. It is important to consider various differential diseases, such as herpes zoster and malignant lymphoma, and to respond carefully in collaboration with other related departments.

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