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Epstein–Barr virus-associated lymphoproliferative disease occurring in a patient with sarcoidosis treated by methotrexate and methylprednisolone

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Theate I, Michaux L, Dardenne S, Guiot Y, Brière J, Emile J, Fabiani FB, Detry R, Gaulard P. Epstein–Barr virus-associated lymphoproliferative disease occurring in a patient with sarcoidosis treated by methotrexate and methylprednisolone.

Eur J Haematol 2002: 69: 248–253. © Blackwell Munksgaard 2002. Abstract:

We describe the case of a 51-yr-old man with systemic sarcoidosis, complicated by the occurrence of a lymphoproliferative disease following a 36-month (duration) immunosuppressive treatment with methotrexate (MTX) and methylprednisolone. Four years after the onset of sarcoidosis, the patient presented a large necrotizing anal fistula. Pathological examination of this lesion showed a diffuse polymorphic infiltrate containing large Epstein–Barr virus (EBV)-positive lymphoid cells associated with areas of necrosis, all features similar to classical B-cell lymphoproliferative disorders occurring in immunosuppressed solid-organ recipients. MTX has been recently implicated in the development of lymphoproliferative disease in connective tissue diseases. This case supports the hypothesis that immunosuppression therapy may contribute to an increased risk for the development of EBV-associated lymphoproliferative disorders in patients suffering from sarcoidosis.
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Keywords: Epstein–Barr virus; immunosuppression; lymphoproliferative disorder; methotrexate; sarcoidosis

Document Type: Research Article

Affiliations: 1: Pathology, 2: Haematology, and 3: Digestive Surgery, Cliniques Universitaires Saint Luc, Université catholique de Louvain, Brussels, Belgium; 4: Hôpital Saint Louis, Paris, France; 5: Hôpital Paul Brousse, Villejuif, France; 6: Centre Hospitalier Le Mans, France. On behalf of the Groupe d'Etude des Lymphomes de l'Adulte (GELA) 7: Department of Pathology, Hôpital Henri Mondor, Créteil, France;

Publication date: October 1, 2002

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