Abstract
We report a case of methotrexate-associated lymphoproliferative disorder （MTX-LPD） with osteonecrosis of the maxilla. A 74-year-old woman who had been treated for 10 years with methotrexate （MTX） and steroids for rheumatoid arthritis was found to have pain after tooth extraction of the left upper cuspid. We performed a computed tomographic examination and a biopsy, and the pathological diagnosis was granulation tissue formation. We diagnosed this lesion as incomplete healing after extraction, and followed up the patient with oral management. However, the patient’s symptoms suddenly worsened, and we performed another biopsy for a suspected tumor. The pathological diagnosis was MTX-LPD. The local pain disappeared after MTX therapy was stopped. On the 35th day after discontinuation, a sequestrum was isolated from the maxilla under local anesthesia. After the operation, the wound was covered with mucosal epithelium, and there has been no recurrence to date.
