{"@context":{"@vocab":"https://cir.nii.ac.jp/schema/1.0/","rdfs":"http://www.w3.org/2000/01/rdf-schema#","dc":"http://purl.org/dc/elements/1.1/","dcterms":"http://purl.org/dc/terms/","foaf":"http://xmlns.com/foaf/0.1/","prism":"http://prismstandard.org/namespaces/basic/2.0/","cinii":"http://ci.nii.ac.jp/ns/1.0/","datacite":"https://schema.datacite.org/meta/kernel-4/","ndl":"http://ndl.go.jp/dcndl/terms/","jpcoar":"https://github.com/JPCOAR/schema/blob/master/2.0/"},"@id":"https://cir.nii.ac.jp/crid/1390855809769528960.json","@type":"Article","productIdentifier":[{"identifier":{"@type":"DOI","@value":"10.2336/nishinihonhifu.84.218"}},{"identifier":{"@type":"NDL_BIB_ID","@value":"032257614"}},{"identifier":{"@type":"URI","@value":"http://id.ndl.go.jp/bib/032257614"}},{"identifier":{"@type":"URI","@value":"https://ndlsearch.ndl.go.jp/books/R000000004-I032257614"}},{"identifier":{"@type":"URI","@value":"https://www.jstage.jst.go.jp/article/nishinihonhifu/84/3/84_218/_pdf"}},{"identifier":{"@type":"URI","@value":"https://search.jamas.or.jp/link/ui/2022261989"}}],"dc:title":[{"@language":"en","@value":"A Case of Methotrexate-associated Lymphoproliferative Disease Presenting with Multiple Skin Ulcers"},{"@language":"ja","@value":"多発性皮膚潰瘍を呈したメトトレキサート関連リンパ増殖性疾患の 1 例"},{"@language":"ja-Kana","@value":"タハツセイ ヒフ カイヨウ オ テイシタ メトトレキサート カンレン リンパ ゾウショクセイ シッカン ノ 1レイ"}],"dc:language":"ja","description":[{"type":"abstract","notation":[{"@language":"ja","@value":"<p>66 歳，女性。17 年前に発症した関節リウマチに対し 11 年前よりメトトレキサート（methotrexate：MTX）を内服していた。8 カ月前に右下腿を打撲し同部位に潰瘍を生じたという。改善しないため当科紹介となった。右下腿，右大腿，背部に多発する皮膚潰瘍が認められ，周囲に色素沈着と皮下硬結を伴っていた。また CT では右肺下葉に結節影を認めた。右下腿と背部の皮膚生検で真皮から皮下脂肪織に CD20 陽性の大型異型リンパ球が多数浸潤しており，腫瘍細胞は LMP-1，EBER 陽性で組織学的に EBV 感染を確認した。MTX 中止により皮下硬結の範囲は速やかに縮小し，右大腿と背部の潰瘍は約 1 カ月で上皮化した。肺の結節影も縮小傾向で，病理組織像と臨床経過から MTX 関連リンパ増殖性疾患（methotrexate-associated lymphoproliferative disorders：MTX-LPD）と診断した。右下腿の潰瘍は難治だったため，組織学的にリンパ増殖性疾患の所見のないことを確認し植皮術を行った。その後は寛解を維持し，リンパ増殖性疾患の再発および関節リウマチの増悪はない。MTX-LPD の皮膚潰瘍は多発例が多く，紅斑，結節，腫瘤といった原発疹が存在することを特徴とするが，単発例も存在し下腿は好発部位の一つである。MTX を内服中の患者に下腿潰瘍を生じた場合，MTX-LPD を鑑別に挙げる必要がある。</p>"}],"abstractLicenseFlag":"disallow"}],"creator":[{"@id":"https://cir.nii.ac.jp/crid/1410855809769528962","@type":"Researcher","foaf:name":[{"@language":"en","@value":"SHIOMICHI Yasuko"},{"@language":"ja","@value":"塩道 泰子"}],"jpcoar:affiliationName":[{"@language":"ja","@value":"北九州市立医療センター皮膚科"},{"@language":"en","@value":"Department of Dermatology, Kitakyushu Municipal Medical Center"},{"@language":"en","@value":"Department of Dermatology, Graduate School of Medical Sciences, Kyushu University"},{"@language":"ja","@value":"九州大学大学院医学研究院皮膚科学分野"}]},{"@id":"https://cir.nii.ac.jp/crid/1410855809769528961","@type":"Researcher","foaf:name":[{"@language":"ja","@value":"種子島 佳子"},{"@language":"en","@value":"TANEGASHIMA Keiko"}],"jpcoar:affiliationName":[{"@language":"ja","@value":"北九州市立医療センター皮膚科"},{"@language":"en","@value":"Department of Dermatology, Kitakyushu Municipal Medical Center"},{"@language":"en","@value":"Department of Dermatology, Graduate School of Medical Sciences, Kyushu University"},{"@language":"ja","@value":"九州大学大学院医学研究院皮膚科学分野"}]},{"@id":"https://cir.nii.ac.jp/crid/1410855809769528965","@type":"Researcher","foaf:name":[{"@language":"ja","@value":"廣瀬 朋子"},{"@language":"en","@value":"HIROSE Tomoko"}],"jpcoar:affiliationName":[{"@language":"ja","@value":"北九州市立医療センター皮膚科"},{"@language":"en","@value":"Department of Dermatology, Kitakyushu Municipal Medical Center"},{"@language":"ja","@value":"九州大学大学院医学研究院皮膚科学分野"},{"@language":"en","@value":"Department of Dermatology, Graduate School of Medical Sciences, Kyushu University"}]},{"@id":"https://cir.nii.ac.jp/crid/1410855809769528960","@type":"Researcher","foaf:name":[{"@language":"en","@value":"NISHISAKA Hiroaki"},{"@language":"ja","@value":"西坂 浩明"}],"jpcoar:affiliationName":[{"@language":"en","@value":"Department of Rheumatology, Kitakyushu Municipal Medical 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