Evidence mapPaperPMID 40919085Full record

ArticleNeuro-ophthalmology (Aeolus Press)2025

Methotrexate-Associated Lymphoproliferative Disorder in a Patient with Polymyalgia Rheumatica Presenting with Double Vision.

Gabriele Berman, Rasoul Amel-Kashipaz, Prem Mahendra, Satheesh Ramalingam, Benjamin Rhodes, Susan Mollan, Ajay Patil

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Article in Neuro-ophthalmology (Aeolus Press), 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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1 · What the graph read from it

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2 · The registry

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4 · The record

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5 · Who and what money

Authors and funding

7 authors.

Gabriele BermanBirmingham Neuro-Ophthalmology, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital, Birmingham, UK.ORCID https://orcid.org/0009-0008-3390-9508
Rasoul Amel-KashipazDepartment of Pathology, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital, Birmingham, UK.
Prem MahendraDepartment of Haematology, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital, Birmingham, UK.
Satheesh RamalingamDepartment of Neuroradiology, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital, Birmingham, UK.
Benjamin RhodesDepartment of Rheumatology, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital, Birmingham, UK.
Susan MollanBirmingham Neuro-Ophthalmology, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital, Birmingham, UK.ORCID https://orcid.org/0000-0002-6314-4437
Ajay PatilBirmingham Neuro-Ophthalmology, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital, Birmingham, UK.ORCID https://orcid.org/0000-0001-7242-2657

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Methotrexate is a commonly employed folate antagonist used as a disease modifying antirheumatic drug. It is recommended by the European League Against Rheumatism Guidelines as an add-on therapy for the treatment of polymyalgia rheumatica. Lymphoproliferative disease developing during methotrexate treatment is recognised as methotrexate-associated lymphoproliferative disorder. We describe a patient with polymyalgia rheumatica on long-term methotrexate treatment presenting with double vision and systemic symptoms concerning for giant cell arteritis. Two months prior, she had noticed a mass of the right nasal dorsum. Neuroimaging showed several lesions of the nasal cavity and a clival lesion. Nasal cavity biopsy revealed diffuse large B-cell lymphoma, and FDG-PET/CT 3 weeks after methotrexate cessation showed significant interval disease regression, confirming the diagnosis of methotrexate-associated lymphoproliferative disorder. Follow-up FDG-PET/CT 4 months after methotrexate cessation showed complete radiological regression of lymphoproliferative lesions. The cumulative incidence of methotrexate-associated lymphoproliferative disorder in patients with rheumatoid arthritis treated with methotrexate has been reported to be up to 4.7% at 10 years in a retrospective study. Cessation of methotrexate resulted in spontaneous regression in 59% of patients. It is important to include methotrexate-associated lymphoproliferative disorder on the differential diagnosis for patients on long-term methotrexate treatment who present with neuro-ophthalmic symptoms and signs as tissue diagnosis prior to commencing steroid treatment is essential to secure the diagnosis and guide treatment.

Indexed as

Diffuse large B-cell lymphomaFDG-PET/CTgiant cell arteritislymphoproliferative disordermethotrexatepolymyalgia rheumatica

Identifiers

PMID40919085
PMCPMC12409854

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