Methotrexate‐associated lymphoproliferative disorder with an osteolytic vertebral lesion in an elderly patient with rheumatoid arthritis: A case report

Hirata, Chihiro; Kenzaka, Tsuneaki; Akita, Hozuka

doi:10.1111/jcpt.13415

Cited by 2 publications

(2 citation statements)

References 10 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…4 , 6 , 7 However, bone involvement is rare, accounting for only approximately 3% of all MTX-LPDs. 8 MTX-LPD in the spinal region is also rare, with only 5 cases reported to date ( Table 1 2 , 3 , 7 , 9 , 10 ). To the best of our knowledge, this is the first reported case in the sacral spine.…”

Section: Discussionmentioning

confidence: 99%

“… 1 MTX has gained acceptance in recent years as a first-line treatment for rheumatoid arthritis (RA) and other systemic rheumatic diseases, and the incidence of MTX-LPD is therefore expected to continue increasing. 2 Although the first reported case of MTX-LPD was reported in 1991 as lymphoma in a patient with RA who had received MTX, 1 it has not been well characterized due to its rarity. Spinal lesions are rare in MTX-LPD, and no cases of sacrum have been reported to date.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

The first case of methotrexate-associated lymphoproliferative disorder in the sacrum: a case report

Yamaguchi,

Morimoto,

Toda

et al. 2023

BJR|Case Reports

View full text Add to dashboard Cite

Methotrexate (MTX) is a drug used for treating rheumatoid arthritis. Recently, the reported incidence of Methotrexate-associated lymphoproliferative disease (MTX-LPD) has increased, especially in Japan. Extranodal involvement is observed in half of MTX-LPD cases. However, only a few spinal lesions have been reported, with none in the sacrum. Additionally, Epstein-Barr virus (EBV) infection has also been implicated in the pathogenesis of MTX-LPD. Herein, we describe the case of a 74-year-old woman with MTX-LPD in the sacral spine who complained of severe back pain and nocturnal pain. Radiographs revealed a tumour on the right wing of the sacrum and a positive EBV immunoglobulin G antibody titre. MTX-LPD was suspected based on imaging findings and a history of MTX administration. A pathological examination was performed on the CT-guided biopsy specimen. The histopathological diagnosis was MTX-LPD, and MTX was discontinued. Three months after MTX administration ended, the tumour tended to shrink, and one year later, significant tumour shrinkage was observed. This experience suggests that MTX-LPD can be treated by discontinuing MTX administration. Therefore, early and accurate diagnosis is required, as is avoiding unnecessary treatment such as surgery. MTX-LPD should be considered, especially in spinal origin tumours in EBV-infected patients on methotrexate.

show abstract