CD8-positive T-cell lymphoproliferative disorder associated with Epstein-Barr virus-infected B-cells in a rheumatoid arthritis patient under methotrexate treatment.

Abstract

We report a 48-year-old female who developed lymphoproliferative disorder (LPD) during treatment of rheumatoid arthritis (RA) with methotrexate (MTX). She presented with multiple tumors in the cervical lymph nodes (LNs), multiple lung shadows and round shadows in both kidneys with pancytopenia and a high CRP level. The LN showed CD8-positive T-cell LPD associated with Epstein-Barr (EB) virus-infected B-cells. Clonality assays for immunoglobulin (Ig) heavy chain and T-cell receptor gamma (TCRγ) were negative. The cessation of MTX without chemotherapy resulted in the complete disappearance of the tumors and abnormal clinical features. We compared this case with previously published ones and discuss the pathological findings, presuming that the proliferation of CD8 T-cells was a reactive manifestation to reactivated EB virus-infected B-cells.

• Authors: Hitoshi Koji, Takuya Yazawa, Kimimasa Nakabayashi, Yasunori Fujioka, Hiroshi Kamma, Akira Yamada
• Journal: Modern rheumatology (Mod Rheumatol) Vol. 26 Issue 2 Pg. 271-5 ( 2016) ISSN: 1439-7609 [Electronic] England
• PMID: 24386983 (Publication Type: Case Reports, Journal Article)

Chemical References

• Methotrexate

Topics

• Arthritis, Rheumatoid (complications, drug therapy, pathology)
• B-Lymphocytes (pathology, virology)
• CD8-Positive T-Lymphocytes
• Epstein-Barr Virus Infections (complications, pathology)
• Female
• Herpesvirus 4, Human
• Humans
• Lymph Nodes (pathology)
• Lymphoproliferative Disorders (complications, pathology)
• Methotrexate (therapeutic use)
• Middle Aged