Epstein–Barr virus and methotrexate-related CNS lymphoma in a patient with rheumatoid arthritis

Patients with rheumatoid arthritis (RA), especially those treated with methotrexate (MTX), might have an increased risk of lymphoproliferative disorders that are associated with Epstein–Barr virus (EBV). We describe a case of EBV-associated central nervous system (CNS) lymphoma (diffuse large B-cell...

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Bibliographic Details
Published in:Modern rheumatology 2013-07, Vol.23 (4), p.832-836
Main Authors: Migita, Kiyoshi, Miyashita, Taiichiro, Mijin, Toma, Sakito, Sohko, Kurohama, Hirokazu, Ito, Masahiro, Toda, Keisuke, Tsustumi, Keisuke, Baba, Hiroshi, Izumi, Yasumori, Kawakami, Atsushi, Niino, Daisuke, Ohshima, Kouichi
Format: Article
Language:English
Subjects:
Abatacept
Antirheumatic Agents - adverse effects
Antirheumatic Agents - therapeutic use
Arthritis, Rheumatoid - complications
Arthritis, Rheumatoid - drug therapy
Arthritis, Rheumatoid - virology
Brain Neoplasms - chemically induced
Brain Neoplasms - complications
Brain Neoplasms - virology
Case Report
Epstein-Barr virus
Epstein-Barr Virus Infections - complications
Female
Humans
Immunoconjugates - therapeutic use
Lymphoma
Lymphoma, Large B-Cell, Diffuse - chemically induced
Lymphoma, Large B-Cell, Diffuse - complications
Lymphoma, Large B-Cell, Diffuse - virology
Medical treatment
Medicine
Medicine & Public Health
Methotrexate - adverse effects
Methotrexate - therapeutic use
Middle Aged
Nervous system
Orthopedics
Retreatment
Rheumatoid arthritis
Rheumatology
Risk assessment
Treatment Outcome
Tumors
Viruses
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Description
Summary:Patients with rheumatoid arthritis (RA), especially those treated with methotrexate (MTX), might have an increased risk of lymphoproliferative disorders that are associated with Epstein–Barr virus (EBV). We describe a case of EBV-associated central nervous system (CNS) lymphoma (diffuse large B-cell lymphoma) in a patient with RA on a short course of MTX treatment. The neoplastic cells express the B-cell surface markers (CD20, Pax-5 and CD30), and EBV-encoded RNA was demonstrated by in situ hybridization. The patient’s lymphoma did not recur for the 8-year follow-up period after the tumor resection and cessation of MTX. MTX may promote EBV-positive CNS lymphoma in RA patient due to its immunosuppressive properties as well as reactivating latent EBV infection.
ISSN:1439-7595
1439-7609
DOI:10.1007/s10165-012-0717-7