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


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


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

Full Text: HTML PDF

Browse  Journals  


Journal of Clinical Medicine Research

Journal of Endocrinology and Metabolism

Journal of Clinical Gynecology and Obstetrics


World Journal of Oncology

Gastroenterology Research

Journal of Hematology


Journal of Medical Cases

Journal of Current Surgery

Clinical Infection and Immunity


Cardiology Research

World Journal of Nephrology and Urology

Cellular and Molecular Medicine Research


Journal of Neurology Research

International Journal of Clinical Pediatrics



Journal of Medical Cases, monthly, ISSN 1923-4155 (print), 1923-4163 (online), published by Elmer Press Inc.                     
The content of this site is intended for health care professionals.
This is an open-access journal distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License, which permits unrestricted
non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Creative Commons Attribution license (Attribution-NonCommercial 4.0 International CC-BY-NC 4.0)

This journal follows the International Committee of Medical Journal Editors (ICMJE) recommendations for manuscripts submitted to biomedical journals,
the Committee on Publication Ethics (COPE) guidelines, and the Principles of Transparency and Best Practice in Scholarly Publishing.

website: www.journalmc.org   editorial contact: editor@journalmc.org
Address: 9225 Leslie Street, Suite 201, Richmond Hill, Ontario, L4B 3H6, Canada

© Elmer Press Inc. All Rights Reserved.

Disclaimer: The views and opinions expressed in the published articles are those of the authors and do not necessarily reflect the views or opinions of the editors and Elmer Press Inc. This website is provided for medical research and informational purposes only and does not constitute any medical advice or professional services. The information provided in this journal should not be used for diagnosis and treatment, those seeking medical advice should always consult with a licensed physician.