Case report: Management of Epstein–Barr virus positive and methotrexate‐associated B‐cell lymphoma

Abstract

INTRODUC TI ONMethotrexate (MTX), a folic acid antagonist, is effective against various autoimmune diseases, including rheumatoid arthritis (RA). 1 However, though MTX benefits patients with RA, it may cause lymphoproliferative disease (LPD) in such patients. 2 Ellman et al. reported the first case of MTX-induced lymphoma in a patient with RA in 1991. 3 Subsequently, the World Health Organization (WHO) has added MTXinduced LPD to its existing categories of LPD, classifying it as "other iatrogenic immunodeficiency-associated LPD" (OIIA LPD). 2 In patients with OIIA LPD, 40%-50% of primary lesions exhibit an extranodal pattern at different anatomical sites. 1 Diffuse large Bcell lymphoma (DLBCL) is the most common histopathological type. 1 In a previous study, following cessation of MTX treatment, spontaneous regression of OIIA LPD was observed in approximately 60% of patients with RA. 4 Nevertheless, another study reported that chemotherapy and targeted therapies, particularly regimens involving rituximab, are effective against OIIA LPD. 5Herein, we describe a patient with RA and MTX-induced DLBCL who was initially controlled with R-miniCHOP and MTX discontinuation. However, the patient later relapsed upon MTX readministration and was subsequently managed via R-CVOP chemotherapy.