Vol.23 No.4

Case Report

Epstein?Barr virus and methotrexate-related CNS lymphoma in a patient with rheumatoid arthritis

Authors

Kiyoshi Migita1 , Taiichiro Miyashita1 , Toma Mijin1 , Sohko Sakito2 , Hirokazu Kurohama3 , Masahiro Ito3 , Keisuke Toda4 , Keisuke Tsustumi4 , Hiroshi Baba4 , Yasumori Izumi1 , Atsushi Kawakami5 , Daisuke Niino6

  • Department of General Internal Medicine and Rheumatology, Clinical Research Center, NHO National Nagasaki Medical Center, Kubara 2-1001-1, Omura 856-8652, Japan
  • Department of Rheumatology, Sadamatsu Hospital, Ono-machi 332, Omura 850-0034, Japan
  • Department of Pathology, NHO National Nagasaki Medical Center, Kubara 2-1001-1, Omura 856-8652, Japan
  • Department of Neurosurgery, NHO National Nagasaki Medical Center, Kubara 2-1001-1, Omura 856-8652, Japan
  • Department of Rheumatology, Nagasaki University Hospital, Nagasaki, Japan
  • Department of Pathology, School of Medicine, Kurume University, Asashi-machi 67, Kurume 830-0011, Japan
Received:

17 May 2012

Accepted:

25 June 2012

Published online:

24 July 2012

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Abstract

Patients with rheumatoid arthritis (RA), especially those treated with methotrexate (MTX), might have an increased risk of lymphoproliferative disorders that are associated with Epstein?Barr virus (EBV). We describe a case of EBV-associated central nervous system (CNS) lymphoma (diffuse large B-cell lymphoma) in a patient with RA on a short course of MTX treatment. The neoplastic cells express the B-cell surface markers (CD20, Pax-5 and CD30), and EBV-encoded RNA was demonstrated by in situ hybridization. The patient’s lymphoma did not recur for the 8-year follow-up period after the tumor resection and cessation of MTX. MTX may promote EBV-positive CNS lymphoma in RA patient due to its immunosuppressive properties as well as reactivating latent EBV infection.

Key words

CNS lymphoma, Epstein?Barr virus, Methotrexate, Rheumatoid arthritis