小腸穿孔を契機に診断に至った小腸多発潰瘍を伴うメトトレキサート関連リンパ増殖性疾患の一例

A ８６-year-old woman who had been treated for rheumatoid arthritis（RA）with methotrexate （MTX）for５years, presented another hospital because of abdominal pain. An abdominal CT scan showed ascites and free air in the abdominal cavity. She diagnosed peritonitis due to gastrointestinal perforation, and emergency surgery was performed in our hospital on the day of admission. A ３ mm perforation of the ileum was identified, and there was multiple ulcer near the perforation. Small bowel partial resection was performed, including both lesions. Postoperative histopathological examination revealed the diagnosis of MTX-LPD, and MTX was discontinued after surgery. Currently,６months after surgery, the patient is still alive without any progression of the lymphoma.
MTX-LPD is still uncommon side effect of MTX. So we have to consider MTX maybe occur gastrointestinal perforation with immunocompromised patient.