Lung and Systemic Mass Shadows due to Methotrexate-associated Lymphoproliferative Disease with Pulmonary Aspergillosis Diagnosed by Multiple Approaches: A Case Report

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Pulmonary malignancies coexisting with opportunistic infections can often be challenging to diagnose. In this study, we present an unusual case of methotrexate-associated lymphoproliferative disease (MTX-LPD) coexisting with Aspergillus infection, during treatment of psoriatic arthritis, which presented as multiple systemic mass shadows, including pulmonary mass shadows. Though suspected of being lung cancer initially, bronchoscopy revealed the presence of only Aspergillus; subsequent computed tomography-guided adrenal and direct skin biopsies have confirmed the diagnosis of LPD associated with MTX. Although coexistence of Aspergillus infection in lymphoma is considered unusual, clinicians need to be vigilant about opportunistic infections in patients taking MTX or those who are immunocompromised; thus, these pathogens should be considered when determining differential diagnosis. Furthermore, rather than performing bronchoscopy multiple times, there are a number of examinations that can make the diagnostic process more efficient, as in this case.