Abstract
Methotrexate, used as a disease-modifying agent in the treatment of rheumatoid arthritis and other connective tissue diseases, may depress the immune system and increase the already high risk of Epstein–Barr virus infection in this immune-challenged patient population. The combined impact of methotrexate and Epstein–Barr virus may induce lymphoproliferative disorders involving skin, lung, nodes and central nervous system. The authors present a case of dermatomyositis with methotrexate-related and Epstein–Barr-associated thoracic spinal and paraspinal diffuse large B-cell lymphoma.
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