Epstein–Barr virus and methotrexate-related CNS lymphoma in a patient with rheumatoid arthritis

Kiyoshi MigitaDepartment of General Internal Medicine and Rheumatology, Clinical Research Center, NHO National Nagasaki Medical Center, Kubara 2-1001-1, Omura 856-8652, JapanCorrespondence[email protected]

Taiichiro MiyashitaDepartment of General Internal Medicine and Rheumatology, Clinical Research Center, NHO National Nagasaki Medical Center, Kubara 2-1001-1, Omura 856-8652, Japan

Toma MijinDepartment of General Internal Medicine and Rheumatology, Clinical Research Center, NHO National Nagasaki Medical Center, Kubara 2-1001-1, Omura 856-8652, Japan

Sohko SakitoDepartment of Rheumatology, Sadamatsu Hospital, Ono-machi 332, Omura 850-0034, Japan

Hirokazu KurohamaDepartment of Pathology, NHO National Nagasaki Medical Center, Kubara 2-1001-1, Omura 856-8652, Japan

Masahiro ItoDepartment of Pathology, NHO National Nagasaki Medical Center, Kubara 2-1001-1, Omura 856-8652, Japan

Keisuke TodaDepartment of Neurosurgery, NHO National Nagasaki Medical Center, Kubara 2-1001-1, Omura 856-8652, Japan

Keisuke TsustumiDepartment of Neurosurgery, NHO National Nagasaki Medical Center, Kubara 2-1001-1, Omura 856-8652, Japan

Hiroshi BabaDepartment of Neurosurgery, NHO National Nagasaki Medical Center, Kubara 2-1001-1, Omura 856-8652, Japan

Yasumori IzumiDepartment of General Internal Medicine and Rheumatology, Clinical Research Center, NHO National Nagasaki Medical Center, Kubara 2-1001-1, Omura 856-8652, Japan

Atsushi KawakamiDepartment of Rheumatology, Nagasaki University Hospital, Nagasaki, Japan

Daisuke NiinoDepartment of Pathology, School of Medicine, Kurume University, Asashi-machi 67, Kurume 830-0011, Japan

Kouichi OhshimaDepartment of Pathology, School of Medicine, Kurume University, Asashi-machi 67, Kurume 830-0011, Japan

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Abstract

Patients with rheumatoid arthritis (RA), especially those treated with methotrexate (MTX), might have an increased risk of lymphoproliferative disorders that are associated with Epstein–Barr virus (EBV). We describe a case of EBV-associated central nervous system (CNS) lymphoma (diffuse large B-cell lymphoma) in a patient with RA on a short course of MTX treatment. The neoplastic cells express the B-cell surface markers (CD20, Pax-5 and CD30), and EBV-encoded RNA was demonstrated by in situ hybridization. The patient’s lymphoma did not recur for the 8-year follow-up period after the tumor resection and cessation of MTX. MTX may promote EBV-positive CNS lymphoma in RA patient due to its immunosuppressive properties as well as reactivating latent EBV infection.

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Epstein–Barr virus and methotrexate-related CNS lymphoma in a patient with rheumatoid arthritis

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