Abstract
Methotrexate-associated lymphoproliferative disorder (MTX-LPD) is defined as an “other iatrogenic immunodeficiency-associated lymphoproliferative disorder (LPD)” in the WHO Classification, 4th edition, that develops in patients with autoimmune diseases such as rheumatoid arthritis (RA) and who are under methotrexate (MTX) treatment. One of the characteristics of this disease is that remission may be achieved only with the cessation of MTX in some cases.
We report herein on four cases of head and neck MTX-LPD. The patients were in their sixties to eighties, and comprised three females and one male. They were suspected of having malignant lymphoma with symptoms like sore throat, neck swelling and others, during treatment for RA with MTX. Three cases were diagnosed as having diffuse large B-cell lymphoma and another was diagnosed as having classical Hodgkin lymphoma. Epstein-Barr virus (EBV) is supposed to be associated with the pathogenesis and prognosis of this disease. Remission was achieved in three EBV positive cases only with the cessation of MTX. Chemotherapy was needed in another EBV negative case.
The number of MTX-LPD cases has been increasing along with the increasing use of MTX. Taking a patient history is very important for the diagnosis of MTX-LPD. When this disease is suspected, we should examine the EBV-related protein and should consider the cessation of MTX.
