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methotrexate-associated lymphoproliferation

Description

Signs and Symptoms

Methotrexate-associated lymphoproliferation, also known as MTX-LPD, can manifest with a range of signs and symptoms.

Common symptoms include:

  • Swelling is the predominant manifestation of the disease [2].
  • Abdominal pain
  • Difficulty in breathing
  • Distension of the abdomen
  • Nausea
  • Vomiting
  • Fever
  • Constant feeling of tiredness
  • Night sweats

These symptoms can vary in severity and may be accompanied by other signs of lymphoproliferation, such as lymphadenopathy (enlarged lymph nodes) or splenomegaly (enlarged spleen).

Cutaneous manifestations:

  • Nodules and/or erythematous plaques are common cutaneous manifestations of MTX-LPD [9].
  • Serpentine vessels and fine short hair may be observed in cutaneous lymphomas.

It's essential to note that these symptoms can also be present in other conditions, and a definitive diagnosis of methotrexate-associated lymphoproliferation requires further evaluation and testing.

References: [2] - Swelling is the predominant manifestation of the disease. [9] - Cutaneous manifestations of MTX-LPD are nodules and/or erythematous plaques.

Additional Symptoms

Diagnostic Tests

Diagnostic Tests for Methotrexate-Associated Lymphoproliferative Disorder

Methotrexate-associated lymphoproliferative disorder (MTX-LPD) is a rare and serious complication of methotrexate therapy. Accurate diagnosis is crucial to prevent further complications and initiate appropriate treatment.

Common Diagnostic Tests:

  • Imaging techniques such as:
    • Ultrasound (USG)
    • Computed Tomography (CT-scan)
    • Positron Emission Tomography/Computed Tomography (PET/CT) [5]
  • Histopathological examination of biopsy samples to determine the type and extent of lymphoproliferation [8]

Other Diagnostic Tests:

  • Serum Epstein-Barr nuclear antigen-antibody test
  • Viral capsid antigen-IgG antibody test
  • Contrast-enhanced abdominal computed tomography (CT) to detect tumors or lesions [14]
  • Polymerase Chain Reaction (PCR) to detect clonal rearrangement of the T-cell receptor beta chain gene, consistent with T-cell lymphoma [15]

Importance of Diagnostic Tests:

Accurate diagnosis is essential to differentiate MTX-LPD from other diseases and determine the treatment strategy. Discontinuation of methotrexate can lead to remission in half of the patients with MTX-LPDs [12].

References: [5] Common diagnostic tests and procedures for diagnosing the methotrexate-associated lymphoproliferative disorder are;. Imaging techniques like USG, CT-scan, PET- ... [8] by M Suzuki · 2021 · Cited by 1 — Histopathological diagnosis is important for differentiating the diagnosis of MTX-LPD from other diseases and for determining the treatment strategy, however, ... [12] Methotrexate-associated lymphoproliferative disorder (MTX-LPD) is a major complication of methotrexate (MTX) therapy that can develop in patients with rheumatoid arthritis (RA), although primary hepatic MTX-LPD is extremely rare. Discontinuation of MTX results in remission in half of the patients with MTX-LPDs and is one treatment approach. [14] The serum Epstein-Barr nuclear antigen‐antibody test and viral capsid antigen‐IgG antibody test had positive results. Contrast‐enhanced abdominal computed tomography (CT) revealed a 20‐mm‐diameter hypovascular tumor in the pancreatic tail (Figures 1a-d). The lesion was round in shape with a low‐density area suspected of necrosis ... [15] Furthermore, clonal rearrangement of the T-cell receptor beta chain gene was detected on PCR, consistent with T-cell lymphoma. On the basis of this immunophenotype and histopathological findings by hematoxylin and eosin staining, the diagnosis of MTX-associated angioimmunoblastic T-cell lymphoma-like lymphoproliferative disorder was established.

Treatment

Differential Diagnosis

Additional Information

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