Lymphomatoid granulomatosis and diffuse alveolar damage associated with methotrexate therapy in a patient with rheumatoid arthritis

Hideto Kameda, Ayumi Okuyama, Jun Ichi Tamaru, Shinji Itoyama, Atsushi Iizuka, Tsutomu Takeuchi

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We report on a patient of rheumatoid arthritis (RA) who sequentially developed an axillary mass and a fatal interstitial pneumonia during a 2-year course of methotrexate (MTX) therapy. Autopsy revealed a systemic lymph node involvement and the diagnosis of Epstein-Barr virus (EBV)-related lymphoproliferative disease (LPD) with the features of lymphomatoid granulomatosis was made. The lung tissue specimens revealed a typical diffuse alveolar damage (DAD), and small nodules consisting of atypical B lymphocytes showing positive staining for EBV were sparsely recognized only in basal lungs. This is the first report of a RA patient receiving MTX therapy sequentially developing MTX-associated lymphomatoid granulomatosis and DAD.

Original languageEnglish
Pages (from-to)1585-1589
Number of pages5
JournalClinical Rheumatology
Issue number9
Publication statusPublished - 2007 Sep
Externally publishedYes



  • Diffuse alveolar damage
  • Epstein-Barrvirus
  • Lymphomatoid granulomatosis
  • Methotrexate
  • Rheumatoid arthritis

ASJC Scopus subject areas

  • Rheumatology
  • Immunology

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