Five cases of intraoral methotrexate-associated lymphoproliferative disorders

Abstract

Methotrexate （MTX） is an antitumor drug classified as a folate metabolic antagonist and because of its immuno­suppressive effect, is regarded as an “anchor drug” in the treatment of rheumatoid arthritis （RA）. Recently, methotrexate-associated lymphoproliferative disease （MTX-LPD） has been classified as a critical complication in the RA guidelines. In this study, we examined five cases of MTX-LPD. Symptoms were mainly ulceration, mass formation and lymphadenopathy. All patient symptoms resolved after MTX withdrawal. Because two patients were treated with bone resorption inhibitors, it was necessary to differentiate medication-related osteonecrosis of the jaw （MRONJ）. In this study, the patients had good outcomes with only drug withdrawal, however, some reports describe cases needing treatment with chemotherapy based on malignant lymphoma. We suggest the importance of careful follow-up.