Abstract
A 68-year-old woman had been treated for rheumatoid arthritis (RA) with methotrexate (MTX) for 9 years. She came to our hospital complaining of tiredness, and we suspected a diagnosis of a malignant lymphoma of the terminal ileum based on her blood test and enhanced computed tomography (CT). We considered the possibility of MTX-associated lymphoproliferative disorder (MTX-LPD), and we discontinued MTX administration. Two weeks later, we attempted colonoscopy, and there were erosions and ulcerations in the terminal ileum. The biopsy thereafter suggested malignant lymphoma, but we did not achieve a definitive diagnosis. We attempted a laparoscopy-assisted ileocolectomy for the diagnosis and treatment. The pathological diagnosis was an atypical lymphoid hyperplasia, and we concluded that it was MTX-LPD because of her drug history of MTX.
Seven cases of MTX-LPDs of the ileum, including ours, have been reported, and all of them, except our case, involved emergency surgery for perforation of the ileum. Moreover, there has been no report on laparoscopy-assisted ileocolectomy based on the preoperative diagnosis of MTX-LPD. We report a case of laparoscopy-assisted ileocolectomy based on the preoperative diagnosis of MTX-LPD of the terminal ileum.
