2023 Volume 66 Issue 5 Pages 230-234
Methotrexate-associated lymphoproliferative disorders (MTX-LPD) represent a group of iatrogenic immunodeficiency-associated lymphoproliferative disorders caused by MTX, a medication for rheumatoid arthritis (RA). Recently, Epstein-Barr virus-positive mucocutaneous ulcer (EBVMCU) was defined as an EBV-related disease with a good prognosis among MTX-LPD. MTX-LPD and EBVMCU are in the good prognosis group, that remit spontaneously only with the cessation or reduction of medication in most cases.
We report a case of MTX-LPD and EBVMCU in which a patient developed pharyngeal hemorrhage while undergoing MTX treatment for RA. Even after stopping taking the medication, she experienced repeated massive tonsillar hemorrhage and it was so difficult to stop the bleeding that surgical hemostasis under general anesthesia was necessary.
Although MTX-LPD and EBVMCU generally have favorable prognoses, it should be kept in mind that massive bleeding from ulcerative lesions can be fatal. In addition, for patients who have difficulty in securing an airway due to hemorrhage or who bleed repeatedly in a short period of time, it is important to take prompt measures, such as endotracheal intubation and surgical hemostasis.
