Concise report
Lymphoma in a patient with rheumatoid arthritis receiving
methotrexate treatment: successful treatment with rituximab
M Stewarta, V Malkovskab, J Krishnanc, L Lessinb, W Bartha
a Department of
Rheumatology, Washington Hospital Centre, Washington, DC, USA, b Department of
Haematology-Oncology, Washington Hospital Centre, c Jayashree Krishnan, Department
of Pathology, Washington Hospital Centre
Correspondence to: Dr W F Barth, 2021 K Street, NW, Suite 300, Washington, DC 20006, USA wfbarth{at}worldnet.att.net
Accepted for publication 27 February
2001
A 55 year old man with chronic lymphocytic leukaemia (CLL) and
rheumatoid arthritis (RA), treated for four years with methotrexate (MTX), who developed a B cell non-Hodgkin's lymphoma (B-NHL), is
described. The tumour was localised to the shoulder and axillary lymph
nodes, and positive for Epstein-Barr viral antigens. After failure of
radiation and chemotherapy, a complete remission was achieved with a
combination of antibody treatment (rituximab) and EPOCH. The
development of a second malignancy in a patient with RA receiving MTX
has not been described before. The summation of T cell deficiencies
induced by MTX, CLL, and RA may all have contributed to the development
of the B-NHL.
© 2001 by Annals of the Rheumatic Diseases
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