Spontaneous Regression Of A Renal Mass And Multiple Lung Nodules After Methotrexate Cessation
Iwaki, T., Sugihara, T., Omura, S., Yoshizaki, U., Honda, S., Azuma, T., & Kume, H. (2018). Spontaneous regression of a renal mass and multiple lung nodules after methotrexate cessation. IJU case reports, 1(1), 16–18. https://doi.org/10.1002/iju5.12020
View Original Source →Abstract
INTRODUCTION: Methotrexate has been reported to increase the risk of lymphoproliferative disorders. We report a rare case who was clinically diagnosed with methotrexate-associated lymphoproliferative disorders of the kidney. CASE PRESENTATION: A 77-year-old patient with rheumatoid arthritis had taken low-dose methotrexate for 13 years. The patient developed left renal mass 3 cm in size and multiple pulmonary nodules. Initially, renal malignant tumor with lung metastases was considered and the renal biopsy was planned. However, under possible diagnosis of methotrexate-related lymphoproliferative disorder, we withdrew methotrexate treatment at first and then observed spontaneous regression of the tumorous lesions of the kidney and lungs. CONCLUSION: Although methotrexate-related lymphoproliferative disorder in kidneys is very rare, our case advocates the importance of a relevant differential diagnosis of methotrexate-related lymphoproliferative disorder under the setting of long-term treatment of methotrexate for rheumatoid arthritis.
Case Details
Disease Location
Lung, kidney
Personal Characteristics
77-year-old female. History of rheumatoid arthritis treated with mtx (2–12 mg/week), pituitary adenoma
Clinical Characteristics
Referred for the differential diagnosis of a left renal mass and multiple bilateral lung nodules. Her bilateral lung nodules appeared 1 month ago on a chest x-ray. Contrast-enhanced computed tomography revealed a slightly enhanced, 3-cm left renal mass and multiple pulmonary nodules with a maximal diameter of 2.5 cm. Mtx administration was suspended.
Remission Characteristics
Twenty-four days after stopping treatment, shrinkage of the multiple lung lesions was observed on a chest x-ray. Enhanced computed tomography 7 weeks after the cessation of treatment revealed significant regression of the renal and lung masses. An enhanced computed tomography 8 months later disclosed complete regression of the lung lesions and considerable reduction in the renal mass
Treatment & Mechanisms
Proposed Remission Mechanisms
The relationship of mtx administration with the development of lpd has been much discussed. Therefore, ceasing mtx results in remission.
Clinical Treatment
Metrhotexate discontinuation