CD8(+) T-cell lymphoproliferative disorder associated with Epstein-Barr virus in a patient with rheumatoid arthritis during methotrexate therapy

Mod Rheumatol. 2010 Oct;20(5):500-5. doi: 10.1007/s10165-010-0300-z. Epub 2010 May 1.

Abstract

A 75-year-old woman with rheumatoid arthritis (RA) who was receiving methotrexate (MTX) therapy developed Epstein-Barr virus (EBV)-associated CD8(+) T-cell lymphoproliferative disorder (LPD) and meningoencephalitis. She was successfully treated with acyclovir and corticosteroids plus MTX cessation. T-cell LPD is relatively rare in RA patients receiving MTX. To our knowledge, this is the first report of CD8(+) T-cell LPD with EBV genome occurring during MTX therapy for RA. EBV infection should be carefully monitored to assess severe EBV-associated complications.

Publication types

  • Case Reports

MeSH terms

  • Acyclovir / therapeutic use
  • Aged
  • Antirheumatic Agents / adverse effects*
  • Antiviral Agents / therapeutic use
  • Arthritis, Rheumatoid / drug therapy
  • Arthritis, Rheumatoid / immunology*
  • CD8-Positive T-Lymphocytes / drug effects
  • CD8-Positive T-Lymphocytes / immunology*
  • Epstein-Barr Virus Infections / complications
  • Epstein-Barr Virus Infections / drug therapy
  • Epstein-Barr Virus Infections / immunology*
  • Female
  • Gene Rearrangement, beta-Chain T-Cell Antigen Receptor / genetics
  • Herpesvirus 4, Human / genetics
  • Herpesvirus 4, Human / isolation & purification
  • Humans
  • Immunocompromised Host
  • Immunophenotyping
  • Lymph Nodes / immunology
  • Lymph Nodes / pathology
  • Lymphoproliferative Disorders / drug therapy
  • Lymphoproliferative Disorders / immunology*
  • Lymphoproliferative Disorders / virology
  • Meningoencephalitis / drug therapy
  • Meningoencephalitis / immunology
  • Meningoencephalitis / virology
  • Methotrexate / adverse effects*
  • Methylprednisolone / therapeutic use

Substances

  • Antirheumatic Agents
  • Antiviral Agents
  • Acyclovir
  • Methylprednisolone
  • Methotrexate