Hypercalcemia and Peripheral T-Cell Lymphoma-Type Lymphoproliferative Disorder Associated With Methotrexate in a Rheumatoid Arthritis Patient

Jun Suzuki, Hitoshi Sugawara, Akira Ishii, Mitsuru Maki, Hidenori Sanayama, Hiroshi Matsubayashi, Tamami Watanabe, Wilfred Y. Fujimoto, Masafumi Kakei, Shigeki Yamada

Abstract


We report the case of a 68-year-old Japanese man with rheumatoid arthritis who had progressive fatigue associated with hypercalcemia complicated by peripheral T-cell lymphoma (PTCL)-type methotrexate-associated lymphoproliferative disorder (MTX-LPD). Epstein-Barr virus (EBV) studies indicated presence of the virus in peripheral blood; however, axillary lymph-node biopsy specimen was negative. After the discontinuation of MTX, the Disease Activity Score 28-C-Reactive Protein (DAS28-CRP) improved from 2.9 to 2.2 and both hypercalcemia and lymphadenopathy remitted. We presume that both EBV reactivation under immunosuppressive state and PTCL-type MTX-LPD developing coincidentally may have contributed to hypercalcemia and consequent fatigue.




J Med Cases. 2013;4(9):627-632
doi: http://dx.doi.org/10.4021/jmc1432w

Keywords


Rheumatoid arthritis (RA); Hypercalcemia; Methotrexate (MTX); Methotrexate-associated lymphoproliferative disorder (MTX-LPD); Peripheral T-cell lymphoma (PTCL); Epstein-Barr virus (EBV); Fatigue

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