DUODENAL ULCERATED LESION DUE TO METHOTREXATE-ASSOCIATED LYMPHOPROLIFERATIVE DISORDER: A CASE REPORT

Abstract

A 76-year-old woman complaining of epigastric pain and melena was admitted to our hospital. She had been treated with methotrexate (MTX) due to rheumatoid arthritis (RA) since she was 41 years old. Endoscopic examination revealed an ulcerated lesion in the descending portion of the duodenum. Pathological and immunohistochemical examination of biopsy specimens from the duodenal ulcerated lesion showed diffuse large B-cell lymphoma (DLBCL). Computed tomographic scan showed swelling of lymph nodes in her entire body. We diagnosed methotrexate-associated lymphoproliferative disorder (MTX-LPD), and discontinued administration of MTX. After cessation of MTX, the duodenal ulcerated lesion gradually improved but each lymph node showed reduction or enlargement. Cessation of MTX did not lead to remission, and we started rituximab administration nine months later. Her lymph nodes decreased in size, her soluble interleukin-2 receptor (sIL-2R) level decreased, and the duodenal ulcerated lesion underwent cicatrization. A case report of a duodenal lesion in a patient with MTX-LPD is very rare. When a gastrointestinal lesion is detected in RA patients who are taking MTX, the possibility of MTX-LPD should be kept in mind.