Lymphoproliferative disorder progressing after partial remission following immunosuppressive drugs withdrawal in a patient with rheumatoid arthritis.
Kazuo FukumotoRyu WatanabeMinako TsutsumiTeruhito TakakuwaMasafumi MiyamotoNoriyuki HayashiShinsuke YamadaYutaka FurumitsuMasayuki HinoMotomu HashimotoPublished in: Modern rheumatology case reports (2024)
Lymphoproliferative disorders (LPDs) are serious complications that arise in patients with rheumatoid arthritis (RA) receiving immunosuppressive drugs (ISDs). Here, we report a 73-year-old woman was diagnosed with RA at 60 years of age and treated with methotrexate, bucillamine, prednisolone, and infliximab. She was referred to our hospital with general malaise, pancytopenia, a right adrenal mass, and enlarged periaortic lymph nodes. Epstein-Barr virus (EBV) was detected in serum. We suspected LPD development and performed a bone marrow biopsy, on which no malignant cells could be detected. Upon ISDs withdrawal, her symptoms and blood counts improved, and the right adrenal mass and enlarged lymph nodes regressed. The patient was followed up for clinical LPD. However, 7 months after the initial visit to our hospital, she developed fever and pancytopenia. A repeat bone marrow biopsy confirmed the diagnosis of EBV-positive diffuse large B-cell lymphoma complicated by haemophagocytic syndrome (HPS). After pulse steroid therapy, the patient received rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone therapy, which resulted in a complete response. In conclusion, when LPDs develop in patients with RA during ISD treatment, LPDs can progress and complicate HPS after partial remission following ISDs withdrawal. Therefore, we should carefully follow up RA patients with LPDs, aim to achieve an early diagnosis of LPD, and promptly initiate chemotherapy.
Keyphrases
- epstein barr virus
- diffuse large b cell lymphoma
- rheumatoid arthritis
- disease activity
- bone marrow
- lymph node
- case report
- ankylosing spondylitis
- systemic lupus erythematosus
- interstitial lung disease
- mesenchymal stem cells
- high dose
- healthcare
- induced apoptosis
- ulcerative colitis
- stem cells
- drug delivery
- squamous cell carcinoma
- ultrasound guided
- neoadjuvant chemotherapy
- signaling pathway
- oxidative stress
- sleep quality
- combination therapy
- cancer therapy
- emergency department
- systemic sclerosis
- fine needle aspiration
- depressive symptoms
- radiation therapy
- rectal cancer
- physical activity