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Epstein Barr Virus Related Cutaneous T‐Cell Lymphoma Associated with Juvenile Rheumatoid Arthritis and Methotrexate Therapy
Author(s) -
Barry C.I.,
Rashidi H.H.,
Bifulco C.B.,
DeHoratius D.M.,
Heald P.W.,
Howe J.G.,
Cowper S.E.
Publication year - 2006
Publication title -
journal of cutaneous pathology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.597
H-Index - 75
eISSN - 1600-0560
pISSN - 0303-6987
DOI - 10.1111/j.0303-6987.2006.0511b.x
Subject(s) - medicine , lymphoma , epstein–barr virus , cd30 , pathology , cd15 , methotrexate , juvenile rheumatoid arthritis , cutaneous lymphoma , skin biopsy , rheumatoid arthritis , lymphoproliferative disorders , biopsy , epstein–barr virus infection , arthritis , large cell lymphoma , virus , immunology , mycosis fungoides , biology , cd34 , genetics , stem cell
The risk of lymphoma is significantly increased in patients with juvenile rheumatoid arthritis (JRA) treated with methotrexate (MTX). The most common lymphoma subtypes affecting these patients belong to the B‐cell Non‐Hodgkin category, and are associated with Epstein‐Barr virus (EBV) infection in approximately 25% of cases. EBV rarely infects T‐cells, and is not known to cause T‐cell cutaneous lymphoproliferative disorders in this clinical setting. A 78‐year‐old male, with a long term history of JRA, presented with raised red skin nodules on his right knee, thigh, and shin while undergoing MTX therapy. Histological examination of the lesional biopsy revealed a subcutaneous infiltrate composed of medium to large atypical CD3 positive lymphocytes showing focal positivity in the largest forms for CD30. The presence of EBV in the T‐cells was demonstrated by in situ hybridization for EBV encoded small RNA (EBER). Immunohistochemical stains for CD56, CD8, CD4, and CD15 were negative. To the best of our knowledge, this is the first report of an EBV positive cutaneous T‐cell lymphoma, in a patient with a past medical history of JRA treated with MTX.