J Rheum Dis.  2013 Aug;20(4):238-242. 10.4078/jrd.2013.20.4.238.

Spontaneous Remission of Hodgkin's Lymphoma in a Patient with Systemic Lupus Erythematosus after Withdrawal of Methotrexate

• Cho GM
• Bae MN
• Jung YH
• Kang HS
• Baek IW
• Kim KJ
• Cho CS

• KMID: 2297538
• DOI: http://doi.org/10.4078/jrd.2013.20.4.238

Abstract

Methotrexate is often used in patients with systemic lupus erythematosus for effective disease controlsand steroid-sparing, and has been known to involve the development of lymphoproliferative disorders for patients with autoimmune diseases. We report a case of spontaneous regression of Epstein-Barr virus-positive methotrexate-associated Hodgkin's lymphoma in a 24-year-old woman with systemic lupus erythematosus. Following 6 months of treatment with low-dose methotrexate, the patient developed a neck mass in the right submandibular area. A computed tomography scan of the neck, chest and abdomen revealed multiple enlarged lymph nodes. Excisional biopsy of the neck masses confirmed infiltrations of malignant lymphoid cells that were positive for CD15, CD30, and Epstein-Barr virus-encoded RNA. Reduction of the mass was observed 3 weeks after withdrawing from the methotrexate treatment. At 7 months after initial presentation, computed tomography revealed near-complete regression of lymphadenopathy. After 30 months, the patient was still in complete clinical remission.

Keyword

Hodgkin's lymphoma; Methotrexate; Systemic lupus erythematosus

MeSH Terms

Abdomen
Autoimmune Diseases
Biopsy
Female
Hodgkin Disease
Humans
Lupus Erythematosus, Systemic
Lymph Nodes
Lymphatic Diseases
Lymphocytes
Lymphoproliferative Disorders
Methotrexate
Neck
Remission, Spontaneous
Thorax
Young Adult
Methotrexate

Figure

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  Figure 1. CT scan of neck, chest and abdomen. (A) Multiple enlarged lymph nodes are observed in the right submandibular, upper right paratracheal and the porta hepatis and portocaval space. (B) 7 months after withdrawal from MTX, near-complete regression of lymphadenopathies are noted.

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  Figure 2. Immunohistochemical staining of the cervical lymph node biopsy specimen demonstrating positive for CD15, CD30 and negative for CD20 (×400).

Reference

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