2017 Volume 39 Issue 5 Pages 430-435
Background. Although some cases of methotrexate (MTX)-associated lymphoproliferative disorder (LPD) have been reported, cases of MTX-LPD with pulmonary nodules are less common. In addition, cases in which bronchial nodules due to MTX-associated with LPD directly observed by bronchoscopy are extremely rare. Case. A 73-year-old woman with rheumatoid arthritis (RA) had been treated with MTX and salazosulfapyridine since June 2011. She was admitted due to sore throat and a right enlarged tonsil in November 2014 and MTX-LPD was suspected. MTX therapy for RA was therefore discontinued and her sore throat improved. However, the symptom relapsed in February 2015. Chest computed tomography (CT) in June of the same year showed multiple nodular shadows in bilateral lungs, and demonstrated the augmentation of the shadows. Therefore, she was introduced to our department and underwent bronchoscopy. The lung and bronchial biopsy findings were consistent with diffuse large B-cell lymphoma (DLBCL), and we diagnosed MTX-LPD based on the clinical course. Conclusions. Physicians should be aware of possible MTX-LPD when multiple nodules are observed in lungs and bronchi in patients with RA with MTX treatment.
