Methotrexate-induced Other Iatrogenic Immunodeficiency-associated Lymphoproliferative Disorder with Diffuse Ground-glass Opacities Diagnosed Using a Cryobiopsy.
Tetsuya Fujii, Maki Asami-Noyama, Shuichiro Ohata et al.
✦ AI-curated · Sources linked
Case in brief
A 77-year-old woman with rheumatoid arthritis and advanced gastric cancer developed diffuse ground-glass opacities on chest CT and markedly elevated serum lactate dehydrogenase. Intravascular lymphoma was considered. Transbronchial lung cryobiopsy provided tissue for histopathological assessment; after multidisciplinary discussion, the findings were diagnosed as diffuse large B-cell lymphoma associated with methotrexate-induced other iatrogenic immunodeficiency-associated lymphoproliferative disorder.
What made this case unusual
Unlike the pulmonary nodules or masses usually described in methotrexate-associated OIIA-LPD, this case showed diffuse ground-glass opacities. Cryobiopsy enabled the tissue diagnosis.
Diagnostic / clinical pearl
Diffuse ground-glass opacities in a patient receiving methotrexate can accompany OIIA-LPD; tissue sampling may be needed when imaging and clinical findings raise concern for another lymphoma.