Abstract
Immunodeficiency-associated lymphoproliferative disorders (LPD) in rheumatoid arthritis are a rare, aggressive, and life-threatening clinical entity. We describe a 60-year-old man who had rheumatoid arthritis that was treated with methotrexate. Eight months after the treatment, the case was diagnosed as Epstein-Barr virus-negative LPD (diffuse large B-cell lymphoma) with abdominal bulky mass and clinical stage IVB at high risk in the international prognostic index. Immediate withdrawal of methotrexate led the patient to achieve complete remission, and 8 subsequent courses of rituximab treatment for the prevention of relapse kept the patient disease-free for 29 months. Our case suggests that these treatments may be an effective, safe, and feasible strategy for immunodeficiency-associated LPD in rheumatoid arthritis.
MeSH terms
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Antibodies, Monoclonal, Murine-Derived / pharmacology
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Antibodies, Monoclonal, Murine-Derived / therapeutic use*
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Antimetabolites, Antineoplastic / pharmacology
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Antimetabolites, Antineoplastic / therapeutic use
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Antirheumatic Agents / pharmacology
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Antirheumatic Agents / therapeutic use*
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Arthritis, Rheumatoid / complications
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Arthritis, Rheumatoid / drug therapy*
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Arthritis, Rheumatoid / immunology
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Disease-Free Survival
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Drug Administration Schedule
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Herpesvirus 4, Human
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Humans
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Immunologic Deficiency Syndromes / complications
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Immunologic Deficiency Syndromes / drug therapy*
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Immunologic Deficiency Syndromes / immunology
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Lymphoma, Large B-Cell, Diffuse / drug therapy*
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Lymphoma, Large B-Cell, Diffuse / etiology
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Lymphoma, Large B-Cell, Diffuse / immunology
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Male
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Methotrexate / pharmacology
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Methotrexate / therapeutic use
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Middle Aged
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Recurrence
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Rituximab
Substances
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Antibodies, Monoclonal, Murine-Derived
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Antimetabolites, Antineoplastic
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Antirheumatic Agents
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Rituximab
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Methotrexate