BURKITT LYMPHOMA SECONDARY TO METHOTREXATE USE

Abstract

SESSION TITLE: Fellows Disorders of the Pleura Posters SESSION TYPE: Fellow Case Report Posters PRESENTED ON: October 18-21, 2020 INTRODUCTION: Burkitt lymphoma (BL) is a highly aggressive, rapidly growing B cell non-Hodgkin lymphoma. There are three subtypes that are currently recognized including sporadic, endemic, and immunodeficiency-associated. Most commonly, immunodeficiency-associated BL is seen in HIV-positive patients, transplant recipients and congenital immunodeficiency. We present a case of Burkitt lymphoma in a young patient whose only risk factor was methotrexate use for uveitis. CASE PRESENTATION: 25 year old female with past medical history most significant for hypertension and uveitis. She was diagnosed with uveitis at the age of 6 which had been treated with methotrexate for years. She presented with acute (2 days) shortness of breath. Patient’s shortness of breath began the day prior to admission after having dinner. She denied any sick contacts, fevers, chills or abdominal pain. She is active and works as a school teacher. She denied using any illicit drugs, tobacco, or alcohol. She had no family history of cancer. While in the emergency room, patient had a CT thorax which showed no pulmonary embolism but did show a 4cm right hilar mass and large right pleural effusion. Pulmonary service was consulted and a thoracentesis was performed. After the thoracentesis was performed, a CT abdomen was obtained as malignancy was on the differential for metastatic workup, which showed a 15cm ovarian mass. However the patient did not have any abdominal symptoms. Cytology from the thoracentesis was consistent with B-cell lymphoma. Patient eventually underwent an endobronchial ultrasound and fine-needle aspiration and core biopsy of R4 lymph node which were consistent with Burkitt Lymphoma. Bone marrow biopsy also showed EBV+ Burkitt lymphoma with presence of chromosomal translocation of t(8;14). DISCUSSION: Burkitt Lymphoma (BL) presentation is quite heterogenous. BL is Endemic in Africa with majority of cases presenting as facial or jaw bone tumors. Sporadic BL is seen commonly in younger Caucasian patients and presents as abdominal disease with ascites. Immunodeficiency-associated BL often effects lymph nodes, bone marrow and CNS. There are some publication of methotrexate-associated lymphoproliferative disorders and even fewer publications describing methotrexate-associate B cell lymphomas. Here we present a young, African American patient who presented with only shortness of breath and no abdominal symptoms. She fits under sporadic and immunodeficiency-associated category of BL. Given her only risk factor of methotrexate use, she is a rare case of methotrexate causing immunodeficiency and subsequent Burkitt Lymphoma. Interestingly, her treatment of lymphoma included the use of intrathecal methotrexate. CONCLUSIONS: Burkitt Lymphoma presents in very heterogenous ways. Methotrexate is known to cause lymphoproliferative disorders but we present a rare case of methotrexate being associated with Burkitt Lymphoma. Reference #1: Methotrexate-induced B-cell lymphoma. Journal of the American Academy of Dermatology, Volume 79, Issue 3, AB192 Reference #2: Kalisz K, Alessandrino F, Beck R, et al. An update on Burkitt lymphoma: a review of pathogenesis and multimodality imaging assessment of disease presentation, treatment response, and recurrence. Insights Imaging. 2019;10(1):56. Published 2019 May 21. doi:10.1186/s13244-019-0733-7 DISCLOSURES: No relevant relationships by Amish Shah, source=Web Response No relevant relationships by Girish Trikha, source=Web Response