咽頭痛を初発症状としたメトトレキサート（MTX）関連リンパ増殖性疾患例

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We report a case of unusually long rheumatoid arthritis (RA) with methotrexate (MTX) and related factors. A 60-year-old woman with a 35-year RA history and 2 weeks of sore throat. For 19 years before presentation, she had been administrated oral MTX weekly at 7.5 mg. Laryngofiberscopy showed a tumor on the oropharynx, at the left tongue root. Enhanced computed tomography (CT) showed neck swelling and axillary, lateroabdominal subcutaneous, and inguinal lymph nodes, nodular thyroid lesion, lung, and liver. Gastroscopy showed a gastric tumor and uteroscopy a uterine tumor. Fine needle aspiration from a neck lymph node and thyroid showed malignant lymphoma and oropharyngeal, gastric, and uterine biopsy showed diffuse large B cell lymphoma. She was diagnosed elsewhere with MTX-associated lymphoproliferative disorders (MTX-LPD), and MTX was discontinued. Neck lymph node and oropharyngeal tumor shrank 2 weeks after MTX withdrawal, and CT 4 months later showed all lesions had disappeared. One year after MTX withdrawal, the woman had no evidence of recurrence.