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Lymphomatoid granulomatosis and diffuse alveolar damage associated with methotrexate therapy in a patient with rheumatoid arthritis

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Abstract

We report on a patient of rheumatoid arthritis (RA) who sequentially developed an axillary mass and a fatal interstitial pneumonia during a 2-year course of methotrexate (MTX) therapy. Autopsy revealed a systemic lymph node involvement and the diagnosis of Epstein–Barr virus (EBV)-related lymphoproliferative disease (LPD) with the features of lymphomatoid granulomatosis was made. The lung tissue specimens revealed a typical diffuse alveolar damage (DAD), and small nodules consisting of atypical B lymphocytes showing positive staining for EBV were sparsely recognized only in basal lungs. This is the first report of a RA patient receiving MTX therapy sequentially developing MTX-associated lymphomatoid granulomatosis and DAD.

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Authors and Affiliations

  1. Division of Rheumatology/Clinical Immunology, Department of Internal Medicine, Saitama Medical Center, Saitama Medical University, 1981 Tsujido-machi, Kamoda, Kawagoe, Saitama, 350-8550, Japan

    Hideto Kameda, Ayumi Okuyama, Atsushi Iizuka & Tsutomu Takeuchi

  2. Department of Pathology, Saitama Medical Center, Saitama Medical University, 1981 Tsujido-machi, Kamoda, Kawagoe, Saitama, 350-8550, Japan

    Jun-ichi Tamaru & Shinji Itoyama

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  1. Hideto Kameda
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  2. Ayumi Okuyama
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  3. Jun-ichi Tamaru
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  4. Shinji Itoyama
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  5. Atsushi Iizuka
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  6. Tsutomu Takeuchi
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Correspondence to Hideto Kameda.

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Kameda, H., Okuyama, A., Tamaru, Ji. et al. Lymphomatoid granulomatosis and diffuse alveolar damage associated with methotrexate therapy in a patient with rheumatoid arthritis. Clin Rheumatol 26, 1585–1589 (2007). https://doi.org/10.1007/s10067-006-0480-2

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  • DOI: https://doi.org/10.1007/s10067-006-0480-2

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