Methotrexate‐related Lymphomatoid Granulomatosis: A Case Report Of Spontaneous Regression Of Large Tumours In Multiple Organs After Cessation Of Methotrexate Therapy In Rheumatoid Arthritis
Shimada, K., Matsui, T., Kawakami, M., Nakayama, H., Ozawa, Y., Mitomi, H., & Tohma, S. (2007). Methotrexate‐related lymphomatoid granulomatosis: a case report of spontaneous regression of large tumours in multiple organs after cessation of methotrexate therapy in rheumatoid ARThritis. Scandinavian Journal of Rheumatology, 36(1), 64–67. https://doi.org/10.1080/03009740600902403
View Original Source →Abstract
We describe a 54-year-old female patient with rheumatoid arthritis (RA) and Sjögren's syndrome (SS) who presented with right chest pain and a large mass visible in the upper right field of a chest X-ray. Computed tomography (CT) showed multiple tumours in both lungs, the liver, and the spleen. The right lung tumour was 8 cm in diameter with a cavity. Biopsy of the lung and liver revealed lymphomatoid granulomatosis (LG) and diffuse large B-cell lymphoma (DLBCL). These lesions spontaneously regressed after withdrawal of methotrexate without any therapy for the lymphoma. This is the first report of self-limiting LG in a patient, complicated with methotrexate-treated RA.
Case Details
Disease Location
Lungs liver and spleen
Personal Characteristics
54 -year-old female 24 year history of erosive, seropositive rheumatoid arthritis and had been treated with non-steroidal anti-inflammatory drugs, oral glucocorticoids, sodium aurothiomalate, and d-penicillamine, her disease activity remained and sjogrens syndrome
Clinical Characteristics
Just before admission was on oral methotrexate and bucillamine she was admitted because of pain in the right side of her chest, a large abnormal oval-shaped shadow in the upper right lung filed on the chest x-ray and elevated liver enzymes CT revealed multiple tumors in both lungs, the liver and the spleen. There were no intracranial lesions. The largest mass was in the right lung (8cm in diameter) on the bronchovascular bundle and had a cavity methotrexate and bucillamine were withdrawn transbronchial biopsy of the largest mass in the right lung revealed granuloma and vasculitis with blood vessel occlusion and infiltration of histiocytes and large atypical lymphocytes within the vascular wall ultrasound-assisted liver biopsy showed infiltration and proliferation of medium to large atypical lymphocytes with destruction of liver structure immunohistochemical exams showed that atypical lymphocytes were CD79-alpha positive, CD20 positive, and negative for cd 3 and 30. They were also accompanied by CD68+ histiocytes and CD3+ t lymphocytes diagnosis was lymphomatoid granulomatosis and diffuse large b-cell lymphoma
Remission Characteristics
While tests were being conducted, her chest pain disappeared and the lung mass regressed via x-ray she was discharged with follow-ups and no therapy for any malignancies CT 3 months later showed disappearance (i believe complete, but none reported) of the tumors in the liver and spleen and remarkable regression in the lungs arthritis has deteriorated despite rx of salazosulfapyearsidine she is still outpatient without obvious recurrence
Treatment & Mechanisms
Proposed Remission Mechanisms
Mtreatment withdrawal which recovers immune response
Clinical Treatment
Non-steroidal anti-inflammatory drugs, oral glucocorticoids, sodium aurothiomalate, and d-penicillamine for ra 10 years before admisison was being treated with oral methotrexate and bucillamine and just before admission was prescribed these two without glucocorticoids salazosulfapyearsidine
Non-Clinical Treatment
None reported