Article Text
Summary
A 62-year-old woman with rheumatoid arthritis and secondary Sjögren’s syndrome took methotrexate (MTX) 5 mg three times a week regularly but gradually developed an intermittent fever, oral ulcers and productive cough with mucopurulent sputum for about 2 weeks. Image study found multiple nodular lesions and lymphadenopathies in bilateral lungs. Empirical antibiotics for 1 week failed to alleviate the fever. A transbronchial biopsy in the right fourth bronchus showed infiltration of abnormally enlarged lymphoid cells with a surface marker of CD20, some of which also stained positively in situ with Epstein-Barr virus-encoded small RNA and some CD3(+) cells. After a diagnosis of MTX-associated lymphoproliferative disease had been made, MTX was discontinued immediately and intravenous methylprednisolone 125 mg/day was given for 1 week. The clinical condition improved dramatically within 1 month and there was no recurrence after 3-year follow-up.
- rheumatoid arthritis
- radiology
- pneumonia (respiratory medicine)
- musculoskeletal and joint disorders
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Footnotes
Contributors W-FL wrote the manuscript, Y-PC amended the manuscript, C-WL took care of the patient and collected the pertinent data and C-YT verified all the data as well as supervised the whole study.
Competing interests None declared.
Patient consent Obtained.
Provenance and peer review Not commissioned; externally peer reviewed.