Komatsuda, A., Wakui, H., Nimura, T. & Sawada, K. Reversible infliximab-related lymphoproliferative disorder associated with Epstein-Barr virus in a patient with rheumatoid arthritis. Mod. Rheumatol. 18, 315-318

Third Department of Internal Medicine, Akita University School of Medicine, 1-1-1 Hondo, Akita, Japan.
Modern Rheumatology (Impact Factor: 2.4). 02/2008; 18(3):315-8. DOI: 10.1007/s10165-008-0053-0
Source: PubMed


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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    • "Latent infection can be associated with different types of cancers and lymphoproliferative diseases. In transplant recipients receiving immunosuppressive therapy,>.80% of non-Hodgkin lymphomas are associated with EBV.133 Reports of EBV-associated lymphoproliferative disorder in patients on anti-TNF therapy have also been published.134,135 Diagnosis of the primary infection is usually suggested by clinical findings of infectious mononucleosis associated with atypical lymphocytosis on peripheral blood smear.132 "
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    Full-text · Article · Mar 2013 · Drug, Healthcare and Patient Safety
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    • "Finally, serum EBV DNA was never found in a series of anti-EBV IgG-positive patients treated with TNF-alpha blockers [8], while the EBV viral load and the number of IFNγ-producing T cells after viral peptide stimulation were not significantly increased after TNF-alpha blockers in patients with RA or spondylarthropathy [9]. On the other hand, Komatsuda et al. described the case of a RA patient who developed a Hodgkin-like lymphoproliferative disorder, related to EBV, at the 30th month of infliximab treatment, which dramatically regressed after anti-TNFalpha discontinuation [10]. Indeed, it has been observed that the immune response to EBV is slightly impaired in RA patients [11]; consequently, this possible inefficient control of the virus might be exalted by the treatment with TNFalpha blockers in a few RA patients. "
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