An 80-year-old woman with rheumatoid arthritis (RA) had been taking methotrexate (MTX) for many years. One year ago, the patient was followed up at our hospital due to an airway lesion associated with RA, in addition to recurring pneumonia.
In April, she developed a low-grade fever and anorexia. In May, she visited our hospital; results of her blood tests indicated severe inflammation and pancytopenia, and a chest computed tomography scan revealed infiltrative shadows, multiple new nodular shadows, and enlarged lymph nodes in the mediastinum, axilla, and abdomen. Since other iatrogenic immunodeficiency-associated lymphoproliferative disorder (OIIA-LPD) was suspected in addition to bacterial pneumonia, MTX was discontinued, and antimicrobial therapy was commenced. However, the patient rapidly developed multiple organ failure and died 10 days after admission.
Autopsy revealed tumor cell infiltration in the lymph nodes and several organs. Immunostaining results suggested peripheral T-cell lymphoma (PTCL) with Epstein-Barr virus infection. The case was considered to be RA-related LPD rather than OIIA-LPD, as the patient’s condition worsened after discontinuation of MTX, and the histopathology showed PTCL.