The Spontaneous Regression Of Grade 3 Methotrexate-related Lymphomatoid Granulomatosis: A Case Report And Literature Review
Aiko, N., Sekine, A., Umeda, S., Katano, T., Matama, G., Isomoto, K., Otoshi, R., & Ogura, T. (2018). The Spontaneous Regression of Grade 3 Methotrexate-related Lymphomatoid Granulomatosis: A Case Report and Literature Review. Internal medicine (Tokyo, Japan), 57(21), 3163–3167. https://doi.org/10.2169/internalmedicine.0542-17
View Original Source →Abstract
Lymphomatoid granulomatosis (LYG) is a rare lung disorder diagnosed by radiological imaging of multiple pulmonary nodules and occasionally induced by methotrexate (MTX) use. To date, the treatment of LYG has not been standardized. We herein report the case of a patient with grade 3 MTX-related LYG who presented a bulky lung mass. Importantly, the disease condition only improved after the discontinuation of MTX and remained stable for more than 1 year. Chest physicians should be aware that LYG can develop as a single lung mass and spontaneously regress, even without aggressive chemotherapy, following the cessation of MTX.
Case Details
Disease Location
Lung
Personal Characteristics
79-year-old man, ex-smoker (20 pack-year), hemiplegia due to cerebral infarction. 29 year-history of rheumatoid arthritis, which had been treated with methotrexate mtx (6 mg/week), prednisolone (2.5 mg/day), and clopidogrel (75 mg/day).
Clinical Characteristics
Visited the hospital due to cough which had persisted for 5 months. Chest x-ray and contrast-enhanced whole body computed tomography (CT) revealed a single cavitary mass surrounded by ground-glass attenuation in the left lower lobe, and a small amount of bilateral pleural effusion. Ampicillin and sulbactam were administered empirically in consideration of the lung abscess. CT-guided pulmonary biopsy specimen demonstrated vascular infiltration of large atypical lymphoid cells surrounded by small lymphocytes and plasma cells. Immunohistological findings showed that the large atypical lymphoid cells were positive for CD20 and eb-encoded small RNA. Based on these findings, the patient was diagnosed with grade 3 lymphomatoid granulomatosis (lyg).
Remission Characteristics
One month later, the symptoms of lyg disappeared and the lung mass apparently shrunk
Treatment & Mechanisms
Clinical Treatment
Biopsy methotrexate withdrawal
Non-Clinical Treatment
None reported