Hodgkin Lymphoma in an Elderly Rheumatoid Patient on Long Term Methotrexate Therapy: A Case Report

Methotrexate associated lymphoproliferative disorders (MTX-LPD) are lymphomas that develop after administration of methotrexate (MTX). Here, we report a case of MTX-LPD in a 58-year-old female with rheumatoid arthritis (RA) who was on methotrexate for 10 years. She presented with complaint of cough for 1 month with no B symptoms. Chest and abdomen computed tomography showed hilar, mediastinal and abdominal lymphadenopathy. Biopsy and immunohistochemistry confirmed involvement with classical Hodgkin lymphoma. She was advised to stop methotrexate which resulted in complete regression of her lesions on PET CT within 1 month. For patients who are taking MTX for a long time, MTX associated LPD should be considered in the differential diagnosis in patients presenting with diffuse lymphadenopathy to avoid unnecessary treatment as many of these cases can be cured with discontinuation of methotrexate alone.