歯肉潰瘍を契機に診断されたメトトレキサート関連リンパ増殖性疾患の1例

抄録

We report here a case of methotrexate-associated lymphoproliferative disorder (MTX-LPD) diagnosed on detection of gingival ulceration.
A 54-year-old woman presented to our clinic with a chief symptom of multiple maxilla-mandibular gingival ulcers. Histopathological diagnosis was MTX-LPD of the Hodgkin-like lesion type along with EBV positivity. The condition was treated by MTX withdrawal during the 3 months of remission.
We reviewed reports documenting 24 cases of oral MTX-LPD in Japan. Affected sites included the maxillary gingiva (n=13), the mandibular gingiva (n=4), the maxillary-mandibular gingiva (n=1), tongue (n=3), floor of the mouth (n=2), and lips (n=1). Of these 24 cases, 20 ulcers were severe, with 3 involving bony exposure and a fistula. Histopathological analysis revealed 15 DLBCL cases, a Hodgkin-like lesion case, 2 polymorphous B-cell LPD, a B-cell LPD, a T-cell dominant LPD, a polymorphic LPD, and 3 cases of unknown etiology. Nineteen cases were treated with MTX withdrawal, and 5 cases were treated with MTX withdrawal and chemotherapy. With treatment, 21 patients attained remission, 1 patient died of the primary disease, and 1 other died owing to secondary complications. Twenty cases attained remission with the withdrawal of MTX without recurrence.