Oral Methotrexate-related Lymphoproliferative Disease Presenting with Severe Osteonecrosis of the Jaw: A Case Report and Literature Review

Long-term methotrexate (MTX) treatment can cause MTX-related lymphoproliferative disorder (MTX-LPD). We experienced a case of MTX-LPD that was associated with severe osteonecrosis of the jaw mimicking medication-related osteonecrosis of the jaw. The patient was an 81-year-old woman with rheumatoid a...

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Bibliographic Details
Published in:Internal Medicine 2018/02/15, Vol.57(4), pp.575-581
Main Authors: Furukawa, Sachiko, Oobu, Kazunari, Moriyama, Masafumi, Kawano, Shintaro, Sako, Saori, Hayashida, Jun-Nosuke, Matsubara, Ryota, Ogata, Ken-Ichi, Kiyoshima, Tamotsu, Nakamura, Seiji
Format: Article
Language:English
Subjects:
Alveolar bone
Case Report
Epstein-Barr virus
Immunology
Internal medicine
Jaw
Lesions
Literature reviews
Lymphocytes
lymphoma
Maxilla
medication-related osteonecrosis of the jaw
Methotrexate
methotrexate-related lymphoproliferative disorder
Mimicry
Osteonecrosis
Rheumatoid arthritis
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Summary:Long-term methotrexate (MTX) treatment can cause MTX-related lymphoproliferative disorder (MTX-LPD). We experienced a case of MTX-LPD that was associated with severe osteonecrosis of the jaw mimicking medication-related osteonecrosis of the jaw. The patient was an 81-year-old woman with rheumatoid arthritis (RA) who was treated with MTX and bisphosphonate. After 7 years, she was referred to our department for the assessment of giant ulcer and exposure of the alveolar bone of the left maxilla. Histopathological and immunological analyses confirmed a diagnosis of MTX-LPD. At seven months after the cessation of MTX treatment, the ulcerative and necrotic lesions had markedly decreased in size. A 1-year follow-up examination showed no evidence of recurrence and good RA control.
ISSN:0918-2918
1349-7235
DOI:10.2169/internalmedicine.8946-17