Methotrexate‐associated EBV‐positive vasculitis in the skin: a report of two cases simulating rheumatoid vasculitis

Rheumatoid vasculitis (RV) is one of the most serious extra‐articular complications of rheumatoid arthritis (RA), generally treated with a high dose of immunosuppressive drugs. Recently, we encountered two cases of ulcerative vasculitis in methotrexate (MTX)‐prescribed RA patients, which simulated R...

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Published in:Journal of cutaneous pathology 2016-06, Vol.43 (6), p.520-525
Main Authors: Fujimoto, Masakazu, Kaku, Yo, Yamakawa, Noriyuki, Kawabata, Daisuke, Ohmura, Koichiro, Koyanagi, Itsuko, Mimori, Tsuneyo, Kabashima, Kenji, Haga, Hironori
Format: Article
Language:English
Subjects:
Epstein-Barr virus
Epstein–Barr virus (EBV)
methotrexate (MTX)
rheumatoid vasculitis
skin
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Summary:Rheumatoid vasculitis (RV) is one of the most serious extra‐articular complications of rheumatoid arthritis (RA), generally treated with a high dose of immunosuppressive drugs. Recently, we encountered two cases of ulcerative vasculitis in methotrexate (MTX)‐prescribed RA patients, which simulated RV; however, Epstein–Barr virus (EBV)‐encoded RNA in situ hybridization on their skin biopsies revealed many EBV‐positive lymphocytes (over 50 cells/high‐power field) within the vessel walls and perivascular stroma, which led us to the diagnosis of EBV‐related vasculitis instead of RV. Subsequently, both ulcers regressed after the discontinuation of MTX and no recurrence was noted during the follow‐up period. To prevent unnecessary treatment, EBV‐positive vasculitis should be added in the differential diagnosis of lymphocytic vasculitis observed in MTX‐administered RA patients.
ISSN:0303-6987
1600-0560
DOI:10.1111/cup.12690