Methotrexate-associated lymphoproliferative disorder arising in the retromolar triangle and lung of a patient with rheumatoid arthritis

Kudoh, Masanori; Harada, Hiroyuki; Matsumoto, Koshi; Satō, Yoshihiro; Omura, Ken; Ishii, Yoshimasa

doi:10.1016/j.oooo.2014.02.029

Cited by 18 publications

(12 citation statements)

References 7 publications

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“…The interval between initiation of MTX therapy and MTX-induced LPDs varies, with most patients diagnosed after 3-5 years of continuous treatment (8). Several tissues and/or internal organs can be affected, including liver, kidneys, gastrointestinal mucosa, lung, spleen and skin.…”

Section: Discussionmentioning

confidence: 99%

Atypical methotrexate ulcerative stomatitis with features of lymphoproliferative like disorder: Report of a rare ciprofloxacin-induced case and review of the literature

Katsoulas¹,

Chrysomali²,

Piperi³

et al. 2016

J Clin Exp Dent

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Methotrexate (MTX) is an established immunomodulating agent used in low doses (LDMTX) to treat several autoimmune diseases. Ulcerative stomatitis (US) may be observed as a long-term LDMTX adverse effect showing a wide histopathologic spectrum. A 73-year old female presented with painful oral ulcers of 5 days duration. The patient had been under treatment for rheumatoid arthritis with LDMTX, while one week before presentation she was prescribed ciprofloxacin for a urinary infection. Histopathologic examination of a lingual ulcer revealed a polymorphous lymphohistiocytic proliferation with scattered binucleated atypical lymphocytes. Immunohistochemically, most cells were of T-cell lineage while the EBER test was negative and a diagnosis of MTX-induced reactive ulceration was rendered. MTX cessation resulted in complete resolution of the ulcers with no recurrences reported so far. The clinical and histopathologic features of MTX-induced oral ulcers are not always diagnostic and a detailed history and an extensive clinicopathologic investigation may be needed to exclude a lymphoproliferative disorder. Key words:Atypical oral ulcers, ciprofloxacin, lymphoproliferative disorders, methotrexate.

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Section: Discussionmentioning

confidence: 99%

Atypical methotrexate ulcerative stomatitis with features of lymphoproliferative like disorder: Report of a rare ciprofloxacin-induced case and review of the literature

Katsoulas¹,

Chrysomali²,

Piperi³

et al. 2016

J Clin Exp Dent

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“…Although the underlying mechanisms responsible for LPD have not been clarified, several factors, including chronic stimulation of B cells, genomic aberrations, viral infection and drug-induced immunodeficiency, have been considered (4,5,(8)(9)(10)(11)(12)(13)(14). Among agents possibly implicated in the onset of immunodeficiency-associated LPD, MTX is the most representative.…”

Section: Discussionmentioning

confidence: 99%

“…However, lymphoproliferative disease (LPD) is a rare complication of MTX therapy that has received attention since Ellman's first report of lymphoma in a patient with RA who received low-dose MTX (2)(3)(4)(5). In addition, interstitial pneumonitis is known to be a pulmonary side effect of MTX therapy for RA, and pulmonary lesions of LPD are relatively rare (6)(7)(8)(9). In particular, the manifestation of LPD in the form of multiple pulmonary nodules is exceptional.…”

Section: Introductionmentioning

confidence: 99%

Methotrexate-associated Lymphoproliferative Disease with Multiple Pulmonary Nodules in a Patient with Rheumatoid Arthritis

et al. 2015

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Patients with rheumatoid arthritis (RA) treated with methotrexate (MTX) sometimes develop lymphoproliferative disease (LPD). MTX-associated LPD can affect nodal or extranodal sites, including the gastrointestinal tract, skin, lungs, kidneys and soft tissues, at almost equal frequency. However, it is very rare for MTXassociated LPD to manifest as multiple nodules in the lungs. We herein report the case of a RA patient who developed MTX-associated LPD with multiple pulmonary nodules during a 5-year course of MTX therapy.

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“…All seven cases were positive for EBV. 1,[4][5][6][7][8] In terms of treatment, MTX-related LPDs may spontaneously remit after withdrawal of MTX therapy, as the immune system recovers. Approximately 60% of MTX-related LPDs have shown spontaneous remission after withdrawal of MTX.…”

Section: 4-8mentioning

confidence: 99%

“…3 Although stomatitis caused by MTX cytotoxicity may occur, only six cases of gingival MTX-related LPDs have been reported in the English literature. 1,[4][5][6][7][8] In this article we present a case of gingival MTX-related LPD in a 60-year-old male with RA. The local findings were similar to those of bisphosphonate-related osteonecrosis of the jaw (BRONJ).…”

Section: Introductionmentioning

confidence: 99%

Methotrexate‐related lymphoproliferative disorder arising in the gingiva of a patient with rheumatoid arthritis

Horie

Kawano

Kaneko

et al. 2015

Australian Dental Journal

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Methotrexate (MTX) is the primary drug used in the management of rheumatoid arthritis (RA) and other immunemediated inflammatory diseases. MTX is a strong immunosuppressive agent and has been reported to cause iatrogenic immunodeficiency-associated lymphoproliferative disorders (LPDs). Stomatitis caused by MTX-related cytotoxicity may occur, but gingival MTX-related LPDs are rare. In this article we present a case of gingival MTX-related LPD in a 60-year-old male with RA. The local findings of the gingival ulceration and alveolar bone exposure were similar to those of bisphosphonate-related osteonecrosis of the jaw. However, he had never received bisphosphonate therapy. The biopsy specimen of the gingival lesion was diagnosed as diffuse large B-cell lymphoma with Epstein-Barr virus positivity. Immediate withdrawal of MTX resulted in marked remission of the LPD.Keywords: Gingiva, lymphoproliferative disorder, methotrexate.Abbreviations and acronyms: BRONJ = bisphosphonate-related osteonecrosis of the jaw; DLBCL = diffuse large B-cell lymphoma; EBV = Epstein-Barr virus; LPD = lymphoproliferative disorder; MTX = methotrexate; RA = rheumatoid arthritis.

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Methotrexate-associated lymphoproliferative disorder arising in the retromolar triangle and lung of a patient with rheumatoid arthritis

Cited by 18 publications

References 7 publications

Atypical methotrexate ulcerative stomatitis with features of lymphoproliferative like disorder: Report of a rare ciprofloxacin-induced case and review of the literature

Atypical methotrexate ulcerative stomatitis with features of lymphoproliferative like disorder: Report of a rare ciprofloxacin-induced case and review of the literature

Methotrexate-associated Lymphoproliferative Disease with Multiple Pulmonary Nodules in a Patient with Rheumatoid Arthritis

Methotrexate‐related lymphoproliferative disorder arising in the gingiva of a patient with rheumatoid arthritis

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