Abstract |
Rheumatoid vasculitis (RV) is one of the most serious extra-articular complications of rheumatoid arthritis (RA), generally treated with a high dose of immunosuppressive drugs. Recently, we encountered two cases of ulcerative vasculitis in methotrexate (MTX)-prescribed RA patients, which simulated RV; however, Epstein-Barr virus (EBV)-encoded RNA in situ hybridization on their skin biopsies revealed many EBV-positive lymphocytes (over 50 cells/high-power field) within the vessel walls and perivascular stroma, which led us to the diagnosis of EBV-related vasculitis instead of RV. Subsequently, both ulcers regressed after the discontinuation of MTX and no recurrence was noted during the follow-up period. To prevent unnecessary treatment, EBV-positive vasculitis should be added in the differential diagnosis of lymphocytic vasculitis observed in MTX-administered RA patients.
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Authors | Masakazu Fujimoto, Yo Kaku, Noriyuki Yamakawa, Daisuke Kawabata, Koichiro Ohmura, Itsuko Koyanagi, Tsuneyo Mimori, Kenji Kabashima, Hironori Haga |
Journal | Journal of cutaneous pathology
(J Cutan Pathol)
Vol. 43
Issue 6
Pg. 520-525
(Jun 2016)
ISSN: 1600-0560 [Electronic] United States |
PMID | 26955985
(Publication Type: Case Reports)
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Copyright | © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd. |