[A case of iatrogenic immunodeficiency-associated lymphoproliferative disease in a patient treated with methotrexate for rheumatoid arthritis for 9 consecutive years, which Showed natural remission after discontinuation of MTX therapy].
[A case of iatrogenic immunodeficiency-associated lymphoproliferative disease in a patient treated with methotrexate for rheumatoid arthritis for 9 consecutive years, which Showed natural remission after discontinuation of MTX therapy].
复制标题
连续9年甲氨蝶呤治疗类风湿性关节炎患者出现医源性免疫缺陷相关淋巴组织增生性疾病，停药后自然缓解。
DOI：
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发表时间：
2013
期刊：
影响因子：
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通讯作者：
S. Maejima
中科院分区：
文献类型：
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作者：
J. Kaneko;Kazuo Gozu;H. Aoyagi;T. Matsui;Tsuyoshi Yoshida;K. Hasegawa;J. Isogai;S. Maejima
我们报告一例医源性免疫缺陷相关淋巴组织增生性疾病病例的经验，该患者连续9年接受甲氨蝶呤（MTX）治疗类风湿性关节炎，在停止MTX治疗后表现出自然缓解。患者为64岁女性，因吐血、黑便紧急入院。她患有多发性胃溃疡和双侧扁桃体炎并伴有中央溃疡。这些病变的活检引起了弥漫性大 B 细胞淋巴瘤的怀疑。正电子发射断层扫描（PET）-计算机断层扫描（CT）显示咽部、颈部淋巴结、肝脏、脾脏、胃、回肠远端和主动脉旁淋巴结中氟脱氧葡萄糖（FDG）蓄积增加，最大标准摄取值为26.85。血液检查显示乳酸脱氢酶（LDH）（321 U/L）和白细胞介素（IL）-2R（3,531 U/mL）水平升高。停用MTX后，喉咙痛消退，扁桃体炎、淋巴结肿大和溃疡也得到解决。 LDH和IL-2R水平恢复到正常范围内。该患者可归入疾病消退组，在 MTX 诱导的淋巴增殖性疾病患者中预后相对较好。然而，她应该继续定期随访，因为停药后淋巴组织增生性疾病仍有可能复发。
We report our experience with a case of iatrogenic immunodeficiency-associated lymphoproliferative disease in a patient who had been treated with methotrexate (MTX) for rheumatoid arthritis for 9 consecutive years, which showed natural remission after discontinuation of the MTX therapy. The patient was a 64-year-old woman who was admitted emergently to our hospital with hematemesis and melena. She presented with multiple gastric ulcers and bilateral tonsillitis with a central ulcer. Biopsy of these lesions raised the suspicion of diffuse large B-cell lymphoma. Positron emission tomography (PET)- computed tomography( CT) showed increased fluorodeoxyglucose( FDG) accumulation in the pharynx, cervical lymph nodes, liver, spleen, stomach, distal part of the ileum, and para-aortic lymph nodes, with a maximum standard uptake value of 26.85. Blood test showed elevated lactate dehydrogenase( LDH)( 321 U/L) and interleukin( IL)-2R( 3,531 U/mL) levels. After discontinuation of MTX, the sore throat subsided, and the tonsillitis, lymph node enlargement, and ulcers were resolved. The levels of LDH and IL-2R returned to within the normal range. The patient could be categorized into a regressive disease group with relatively favorable prognosis among patients with MTX-induced lymphoproliferative disease. However, she should continue to be followed up regularly because there remains a possibility that lymphoproliferative disease may relapse after the discontinuation of MTX.