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 reported a 73-year-old woman diagnosed with RA at 60 years of age and treated with methotrexate, bucillamine, prednisolone, and infliximab. She was referred to our hospital, Osaka Metropolitan University Hospital, with general malaise, pancytopenia, a right adrenal mass, and enlarged periaortic lymph nodes. Epstein-Barr virus 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 Epstein-Barr virus-positive diffuse large B-cell lymphoma complicated by haemophagocytic syndrome. 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 haemophagocytic syndrome after partial remission following ISDs withdrawal. Therefore, we should carefully follow up RA patients with LPDs, and 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
- lymph node
- bone marrow
- case report
- ankylosing spondylitis
- systemic lupus erythematosus
- mesenchymal stem cells
- healthcare
- interstitial lung disease
- high dose
- induced apoptosis
- blood pressure
- ultrasound guided
- ulcerative colitis
- neoadjuvant chemotherapy
- squamous cell carcinoma
- emergency department
- replacement therapy
- fine needle aspiration
- cell proliferation
- oxidative stress
- cell therapy
- drug induced
- depressive symptoms
- cell cycle arrest
- signaling pathway
- endoplasmic reticulum stress
- systemic sclerosis
- newly diagnosed
- locally advanced
- acute care