Methotrexate-Associated Lymphoproliferative Disorder Arising in a Patient With Adult Still's Disease

Abstract

Patients with immunodeficiency show a higher risk of lymphoproliferative disorders than immunocompetent individuals. Such disorders are recognized in 12% to 15% of patients with ataxia-telangiectasia, in 10% of post‐heart-lung transplantation patients, and in 3% to 4% of patients positive for human immune deficiency virus (HIV). 1 Many immunodeficiency-associated lymphoproliferative disorders have a tendency to present at extranodal sites, a diffuse aggressive histology, a B-cell origin, association with Epstein-Barr virus (EBV), and rapid clinical progression. 2 It is thought that immunodeficiency-associated lymphoproliferative disorders provide an important biological model for the development and progression of lymphoid neoplasia. Such disorders are categorized as lymphoproliferative disease associated with primary immune disorders, lymphomas associated with infection by HIV, post-transplantation lymphoproliferative disorders, and methotrexate (MTX)-associated lymphoproliferative disorders. 3 This report describes an unusual case of MTX-associated lymphoproliferative disorder arising in the maxilla of a patient with adult Still’s disease.