Article

Reversible infliximab-related lymphoproliferative disorder associated with Epstein-Barr virus in a patient with rheumatoid arthritis.

Third Department of Internal Medicine, Akita University School of Medicine, 1-1-1 Hondo, Akita, Japan.
Modern Rheumatology (impact factor: 1.58). 02/2008; 18(3):315-8. DOI:10.1007/s10165-008-0053-0 pp.315-8
Source: PubMed

ABSTRACT A 63-year-old woman with active rheumatoid arthritis (RA) had been treated with methotrexate and prednisolone. She developed cervical lymph node swelling 30 months after the initiation of infliximab therapy. A computed tomography revealed cervical and mediastinal lymph node swelling and multiple nodules (up to 13 mm in diameter) in the lungs. A lymph node biopsy showed infiltration of numerous Hodgkin-like and Reed-Sternberg-like cells. Immunohistological studies showed that these cells were positive for CD15, CD30, and Epstein-Barr virus (EBV) latent membrane protein. In site hybridization revealed the presence of EBV RNA in the nuclei of these cells. EBV DNA was detected in the biopsy specimen by southern blot analysis. She was diagnosed as having EBV-associated lymphoproliferative disorder (LPD). Immunodeficiency-associated LPD related with infliximab therapy was considered. Cessation of infliximab therapy only led to dramatic regression of LPD. This case illustrates that EBV-associated LPDs can occur as part of infliximab adverse effects in patients with RA.

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Keywords

30 months
 
63-year-old woman
 
active rheumatoid arthritis
 
biopsy specimen
 
cervical lymph node
 
computed tomography
 
dramatic regression
 
EBV DNA
 
EBV RNA
 
EBV-associated LPDs
 
EBV-associated lymphoproliferative disorder
 
Epstein-Barr virus
 
Immunohistological studies
 
infliximab adverse effects
 
infliximab therapy
 
lymph node biopsy
 
mediastinal lymph node
 
numerous Hodgkin-like
 
site hybridization
 
southern blot analysis