A Case of Ileal Perforation Caused by a Malignant Lymphoma Following Methotrexate Therapy for Rheumatoid Arthritis

Lymphoproliferative disorder (LPD) is a potentially severe adverse effect of methotrexate (MTX) administration in patients with rheumatoid arthritis (RA). We report a case of MTX -associated LPD (MTX -LPD) in a patient with RA who developed severe pulmonary failure complicated by perforation of the terminal ileum. A 61 -year -old woman with RA receiving MTX complained of dyspnea and abdominal pain. She was diagnosed with intestinal perforation and peritonitis, and underwent immediate abdominal surgery. Pathological examinations of the specimen obtained from the resected ileum and a bone marrow aspirate revealed diffuse large B -cell lymphoma. Steroid therapy failed to improve her respiratory failure, but her condition improved after abdominal surgery and suspension of MTX. MTX -LPD can result in multiple life -threatening conditions ; however, the symptoms are highly variable. RA patients receiving MTX should thus be monitored carefully, and MTX administration should be stopped immediately on suspicion of MTX -LPD.

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A Case of Ileal Perforation Caused by a Malignant Lymphoma Following Methotrexate Therapy for Rheumatoid Arthritis

Cited by 5 publications

References 2 publications

A Resected Case of Methotrexate-Associated Lymphoproliferative Disorder Originated from Hepatoduodenal Lymph Node

A Resected Case of Methotrexate-Associated Lymphoproliferative Disorder Originated from Hepatoduodenal Lymph Node

A Case of Perforation of the Terminal Ileum due to Appendicitis that Repeated Recurrence

Methotrexate-associated lymphoproliferative disorder complicated by severe acute respiratory failure and ileal perforation:a case report

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