Journal of the American Academy of Dermatology
Case reportReversal of multifocal cutaneous lymphoproliferative disease associated with Epstein-Barr virus after withdrawal of methotrexate therapy for rheumatoid arthritis
Section snippets
Case report
The 70-year-old woman consulted for a painful necrotic nodule on the right leg measuring 2.5 cm by 2 cm. A nodule measuring 1 cm was localized in the vicinity (Fig 1). The patient had been treated with MTX 10 mg per week for rheumatoid arthritis for 4 years (cumulative dose: 3.2 g). Histopathologic examination of both lesions showed a massive infiltration of polymorphic cells around deeply located dermal vessels, some of which displayed features of fibrinoid necrosis (Fig 2, A). The infiltrate
Discussion
This is a case of B-cell clonal lymphoproliferative disease, associated with EBV and induced by long term treatment with MTX. The lesions included nodules and skin ulceration, which is atypical for this disease; one case of thoracic skin ulceration was reported previously.8 The complete remission of the lesions after discontinuation of the treatment strongly suggests the causality of MTX in their development. The initial aggravation occurring within the first weeks after withdrawal emphasizes
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Conflicts of interest: None declared.
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