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Unusual manifestation of methotrexate-associated lymphoproliferative disorder as a palatal mass
  1. Takuma Watanabe and
  2. Yukina Teratani
  1. Department of Oral and Maxillofacial Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
  1. Correspondence to Dr Takuma Watanabe; takuma{at}kuhp.kyoto-u.ac.jp

Abstract

Methotrexate-associated lymphoproliferative disorder (MTX-LPD) can occur in the oral cavity, and only a few cases with palatal involvement have been reported. Chemotherapy may be needed if there is no remission after the withdrawal of MTX. We report a case of MTX-LPD presenting with a swelling of the palate that required chemotherapy. A woman in her 70s with rheumatoid arthritis reported a swelling on the left side of the palate. Her condition was diagnosed as Epstein-Barr virus-negative diffuse large B-cell lymphoma (MTX-LPD). Since the mass did not remit after MTX withdrawal, she underwent five courses of chemotherapy. Currently, the patient is in complete remission. In patients on MTX who develop a swelling on the palate, MTX-LPD should be included among the differential diagnostic possibilities. Diagnosis and treatment of MTX-LPD call for consultation with a haematologist. If the mass fails to regress following withdrawal of MTX, appropriate chemotherapy is indicated.

  • Haematology (drugs and medicines)
  • Malignant disease and immunosuppression
  • Unwanted effects / adverse reactions
  • Rheumatology
  • Oral and maxillofacial surgery

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Footnotes

  • Contributors TW and YT wrote up the case report and performed a literature review on methotrexate-associated lymphoproliferative disorder.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.