CD8-positive T-cell lymphoproliferative disorder associated with Epstein-Barr virus-infected B-cells in a rheumatoid arthritis patient under methotrexate treatment

Abstract

We report a 48-year-old female who developed lymphoproliferative disorder (LPD) during treatment of rheumatoid arthritis (RA) with methotrexate (MTX). She presented with multiple tumors in the cervical lymph nodes (LNs), multiple lung shadows and round shadows in both kidneys with pancytopenia and a high CRP level. The LN showed CD8-positive T-cell LPD associated with Epstein-Barr (EB) virus-infected B-cells. Clonality assays for immunoglobulin (Ig) heavy chain and T-cell receptor gamma (TCRγ) were negative. The cessation of MTX without chemotherapy resulted in the complete disappearance of the tumors and abnormal clinical features. We compared this case with previously published ones and discuss the pathological findings, presuming that the proliferation of CD8 T-cells was a reactive manifestation to reactivated EB virus-infected B-cells.

Keywords:

• CD8-positive T-cell
• Epstein-Barr virus
• Lymphoproliferative disorder
• Methotrexate
• Rheumatoid arthritis

Acknowledgement

The authors thank Emeritus Prof. Masato Nose, Ehime University Graduate School of Medicine for providing a critical review of our manuscript and Ms. Ayumi Sumiishi (ISH, IHCS) and Kaoruko Sasamoto (clonality assay), Department of Pathology, Kyorin University School of Medicine for their excellent technical assistance.

Conflict of interest

None.

Ethics

This case report was reviewed and approved by the ethics committee of Kyorin University (No. 376).