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• irreversible hodgkin's lymphoma in 2 patients treated with methotrexate
  vladimir gotlieb
  Published on: 19 October 2008

• Published on: 19 October 2008

  irreversible hodgkin's lymphoma in 2 patients treated with methotrexate

  • vladimir gotlieb, the Brooklyn hospital center
  • Other Contributors:
    • Samer Khaled, Dmitri Baranov, Arun Patel

  Dear Editor

  As it was mentioned in multiple manuscripts related to the topic several different possibilities could explain why the patients develop enlarged lymph nodes. Among those are indolent lymphomas, lymphatic hyperplasia and aggressive lymphomas, including both Hodgkin’s lymphoma and large B-cell lymphoma, which are usually associated with Epstein-Barr infection, The other possibilities include Castelman’s D...

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  Dear Editor

  As it was mentioned in multiple manuscripts related to the topic several different possibilities could explain why the patients develop enlarged lymph nodes. Among those are indolent lymphomas, lymphatic hyperplasia and aggressive lymphomas, including both Hodgkin’s lymphoma and large B-cell lymphoma, which are usually associated with Epstein-Barr infection, The other possibilities include Castelman’s Disease, Monoclonal Gammopathy and Gamma Heavy chain Disease. Most of these conditions regress when immunosuppressive therapy- prednisone and ethotrexate are discontinued.
  We observed 2 cases of IRREVERSIBLE mixed cellularity Hodgkin’s Disease developed by patients treated with methotrexate for Polymyositis.

  First case, a 65 year old African American Female presented to the Emergency Room with generalized weakness and weight loss. She was also found to have inguinal lymphadenopathy. The patient received multiple courses of Methotrexate in the past. Biopsy of the lymph node showed Hodgkin’s disease. At that time methotrexate was stopped and 3months later her lymph nodes decreased in size, the patient clinically improved and was able to get back to her normal routine. However, in another month she felt lymph nodes in the groin again. Cat/Pet scan showed diffuse extension of the disease despite the fact that she never resumed Methotrexate.
  Repeat biopsy confirmed mixed cellularity Hodgkin’s Disease.

  Second case, a 70 year old white male with past medical history of Polymyositis, currently in remission came for evaluation complaining of loss of appetite and insomnia; he also reported 20 pound weight loss over 6 month. Screaning Cat scans revealed bilateral symmetrical mediastinal lymphadenopathy. Lymph node biopsy showed mixed cellularity Hodgkin’s disease. The patient had IgG antibodies against Epstein-Barr virus suggestive of resent viral infection. Though the patient did receive several immunosuppressive drugs in the past he was off methotrexate for at least a year. We made a decision to initiate chemotherapy. Even if lymphoma was induced by methotrexate it would be unlikely to expect it to regress on its own at this moment.
  Cases of IRREVERSIBLE Lymphoma are not as well characterized in the literature as the ones that regress when medications are stopped. We think that this issue remains underreported, so that the treatment scheme is not clear at this moment.

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  Conflict of Interest:
  None declared.

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