Abstract
We report the case of a 68-year-old Japanese man with rheumatoid arthritis who had progressive fatigue associated with hypercalcemia complicated by peripheral T-cell lymphoma (PTCL)-type methotrexate-associated lymphoproliferative disorder (MTX-LPD). Epstein-Barr virus (EBV) studies indicated presence of the virus in peripheral blood; however, axillary lymph-node biopsy specimen was negative. After the discontinuation of MTX, the Disease Activity Score 28-C-Reactive Protein (DAS28-CRP) improved from 2.9 to 2.2 and both hypercalcemia and lymphadenopathy remitted. We presume that both EBV reactivation under immunosuppressive state and PTCL-type MTX-LPD developing coincidentally may have contributed to hypercalcemia and consequent fatigue. J Med Cases. 2013;4(9):627-632 doi: http://dx.doi.org/10.4021/jmc1432w
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