Highly aggressive plasmablastic neoplasms in patients with rheumatoid arthritis treated with methotrexate.
Highly aggressive plasmablastic neoplasms in patients with rheumatoid arthritis treated with methotrexate.
复制标题
用甲氨蝶呤治疗的类风湿性关节炎患者的高度侵袭性浆母细胞肿瘤。
DOI：
10.1016/j.intimp.2019.01.014
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发表时间：
2019
期刊：
影响因子：
--
通讯作者：
Takei Y.
中科院分区：
文献类型：
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作者：
Tabata R;Tabata C;Uesugi H;Takei Y.
类风湿性关节炎患者偶尔会发生淋巴组织增生性疾病。甲氨蝶呤相关淋巴组织增生性疾病是一种淋巴组织增生性疾病或淋巴瘤，患者接受甲氨蝶呤治疗自身免疫性疾病，如类风湿性关节炎。本文报告两例甲氨蝶呤治疗类风湿性关节炎中高度侵袭性浆母细胞淋巴增生性疾病的罕见病例。病例1为68岁女性恶性淋巴瘤白血病转化患者。她接受甲氨蝶呤治疗类风湿性关节炎超过6年。患者表现出快速进展过程，并在住院第2天死亡。死亡后，我们诊断患者为浆母细胞淋巴瘤。病例2为一名80岁女性浆细胞骨髓瘤患者，有甲氨蝶呤治疗类风湿关节炎>5年的病史。虽然化疗后M蛋白下降，但骨髓检查发现浆母细胞进一步增加，2个月后死亡。目前的病例难以诊断，因为恶性浆母细胞增殖难以预测，因为既没有淋巴结肿大，也没有观察到明显的M蛋白。两例均表现为侵袭性特征，预后极差。临床医生应该意识到潜在的恶性浆细胞增生时，在非活动性类风湿性关节炎患者中观察到不明炎症结果。
Patients with rheumatoid arthritis occasionally develop lymphoproliferative disorders. Methotrexate-associated lymphoproliferative disorders is a lymphoproliferative disease or lymphoma in patients treated with methotrexate for autoimmune diseases, such as rheumatoid arthritis. Here we report two rare cases of highly aggressive plasmablastic lymphoproliferative disorders in rheumatoid arthritis treated with methotrexate.Case 1 is a 68-year-old female patient with leukemic transformation of malignant lymphoma. She received methotrexate therapy for rheumatoid arthritis for >6 years. The patient showed rapid progressive course and died on the 2nd hospital day. After the death, we diagnosed the patient as plasmablastic lymphoma. Case 2 is an 80-year-old female patient with plasmablastic plasma cell myeloma, with a history of methotrexate treatment for rheumatoid arthritis for >5 years. Although M-protein was decreased by chemotherapy, bone marrow examination revealed the further increase of plasmablastic cells and she died 2 months later.The present cases were difficult to diagnose because proliferation of malignant plasmablasts was hardly predicted because neither lymph node enlargement nor an evident M-protein was observed. Both cases showed aggressive features and extremely poor prognosis. Clinicians should be aware of the underlying malignant plasmablastic proliferation when inexplicable inflammatory findings are observed in inactive rheumatoid arthritis patients.