Abstract
Case:
A patient with rheumatoid arthritis (RA) who was being treated with methotrexate (MTX) therapy presented with severe swelling of the left elbow. Magnetic resonance imaging showed a tumor-like lesion around the elbow joint. Fluorodeoxyglucose positron emission tomography indicated multiple lesions in the lung and the lymph nodes. An open biopsy of a cervical lymph node was performed, and MTX-related lymphoproliferative disorder (MTX-LPD) was diagnosed. After cessation of the MTX therapy, the elbow swelling regressed, and the patient was in remission of MTX-LPD.
Conclusion:
MTX-LPD should be considered in the differential diagnosis when a patient with RA develops severe joint swelling while on MTX therapy.
MeSH terms
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Antirheumatic Agents / administration & dosage
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Antirheumatic Agents / adverse effects*
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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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Elbow Joint / diagnostic imaging
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Elbow Joint / pathology*
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Female
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Humans
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Lymphoma, Large B-Cell, Diffuse / chemically induced*
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Lymphoma, Large B-Cell, Diffuse / diagnosis
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Lymphoproliferative Disorders / chemically induced*
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Lymphoproliferative Disorders / diagnosis
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Magnetic Resonance Imaging / methods
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Methotrexate / administration & dosage
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Methotrexate / adverse effects*
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Methotrexate / therapeutic use
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Middle Aged
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Patient Outcome Assessment
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Positron-Emission Tomography / methods
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Tomography, X-Ray Computed / methods
Substances
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Antirheumatic Agents
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Methotrexate