Abstract
We report a patient with rheumatoid arthritis (RA) who developed malignant lymphoma of the diffuse large B-cell type in the right submandibular region shortly after initiation of oral methotrexate (MTX). Despite cessation of MTX, the lymphadenopathy did not regress, and only reached complete remission after 3 courses of CHOP therapy followed by irradiation. In this patient highly active RA itself was considered to be the main cause of malignant lymphoma, and MTX might have contributed to the development by modifying the immune system. When RA is highly active, MTX should be used carefully because of the possible development of malignant lymphoma as well as other serious complications.
MeSH terms
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Antineoplastic Combined Chemotherapy Protocols / therapeutic use
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Antirheumatic Agents / adverse effects
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Antirheumatic Agents / therapeutic use*
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Arthritis, Rheumatoid / complications*
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Arthritis, Rheumatoid / drug therapy*
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Cyclophosphamide / therapeutic use
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Doxorubicin / therapeutic use
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Humans
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Lymphoma, B-Cell / drug therapy
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Lymphoma, B-Cell / etiology*
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Lymphoma, Large B-Cell, Diffuse / drug therapy
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Lymphoma, Large B-Cell, Diffuse / etiology*
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Magnetic Resonance Imaging
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Male
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Mandibular Neoplasms / drug therapy
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Mandibular Neoplasms / etiology
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Methotrexate / adverse effects
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Methotrexate / therapeutic use*
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Middle Aged
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Prednisolone / therapeutic use
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Vincristine / therapeutic use
Substances
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Antirheumatic Agents
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Vincristine
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Doxorubicin
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Cyclophosphamide
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Prednisolone
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Methotrexate