抄録
Methotrexate is widely used as an anchor drug for rheumatoid arthritis. However, there are several reports of methotrexate-associated lympho-proliferative disorders, although most of them describe cases which occurred in maxillary gingiva with additional drugs like bisphosphonate. In particular, in almost all cases osteonecrosis of the jaw occurred in maxillary bone. We report a case of methotrexate-associated lympho-proliferative disorder with jaw necrosis in the mandibular gingiva.
A 71-year-old woman who had been treated for 10 years with methotrexate and steroids for rheumatoid arthritis was found to have pain and ulcer after tooth extraction of the lower cuspid. We suspected this lesion was due to incomplete healing after extraction or tumor, so we performed a biopsy for suspected tumor. The pathological diagnosis was methotrexate-associated lympho-proliferative disorder. After methotrexate therapy was stopped, the local pain disappeared. On day 64 after stopping methotrexate, the tooth with bone necrosis was removed under local anesthesia. After operation, the wound was covered with mucosal epithelium, and there has been no recurrence to date.
