[EBV-positive MTX-associated lymphoproliferative disorder and Ig M myeloma in rheumatoid arthritis].
| Autor: | Wernecke M; Klinik für Innere Medizin, Schönklinik Hamburg-Eilbek., Frieling D; Klinik für Diagnostische und Interventionelle Radiologie, Schönklinik Hamburg-Eilbek., Brandl U; Onkologie-Lerchenfeld, Hamburg., Feller A; Hämatopathologie Lübeck, Lübeck., von Wichert G; Klinik für Innere Medizin, Schönklinik Hamburg-Eilbek. |
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| Jazyk: | němčina |
| Zdroj: | Deutsche medizinische Wochenschrift (1946) [Dtsch Med Wochenschr] 2021 Feb; Vol. 146 (4), pp. 262-265. Date of Electronic Publication: 2021 Feb 16. |
| DOI: | 10.1055/a-1328-8468 |
| Abstrakt: | History: An 80-year-old female patient arrived with a pronounced lymphadenopathy and weight loss. 6 years ago she had been diagnosed with rheumatoid arthritis. At the time of arrival, she was administered Methotrexate (MTX) 10 mg/week. Findings and Diagnosis: By lymph node biopsy, a clonal population of both EBV-positive B and T cells was seen. Newly occurring anemia (Hb 10 g/dl), monoclonal gammopathy of the Ig M isotype and detection of 40 % EBV-positive plasma cells in the bone marrow were consistent with the diagnosis of Ig M myeloma. We interpret these findings as a biclonal Epstein Barr Virus-positive Methotrexate-associated lymphoproliferative disorder (MTX-LPD). Treatment and Course: The clinical condition improved immediately after MTX discontinuation. In the follow-up after 4 months, the gamma globulin concentration in serum was significantly reduced (from 51.1 to 34.7 %) and a renewed immune electrophoresis of the serum was without evidence of monoclonal gammopathy. Conclusion: Based on this case, the association of RA with lymphoproliferative disorders can be confirmed - here as an association of RA with biclonal MTX-LPD or multiple myeloma. Therapy with MTX and reactivation of EBV infection are important influencing factors. Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht. (Thieme. All rights reserved.) |
| Databáze: | MEDLINE |
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