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Jornal Português de Gastrenterologia

versão impressa ISSN 0872-8178


NUNES, Ana et al. Intestinal lymphoma in a patient on methotrexate treatment (clinical case). J Port Gastrenterol. [online]. 2013, vol.20, n.1, pp.25-29. ISSN 0872-8178.

Long-term immunosuppressive therapies and chronic inflammatory diseases are both recognized as risk factors for the development of lymphoproliferative disorders. These can progress without obvious symptoms, delaying diagnosis and treatment. We describe a 69 year-old female, with a past history of hysterectomy and radiation therapy for endometrial carcinoma, on immunosuppressive treatment with methotrexate and prednisolone due to long-standing rheumatoid arthritis. She was referred to the Gastroenterology Outpatient Clinic due to diffuse abdominal pain, with weight loss, anorexia and weakness. The pain became located at the right lower quadrant. A moderate anemia was found, and the colonoscopy showed an ulcer at the cecum and superficial ulcerations in the distal ileum. Biopsies were compatible with Crohn’s disease. Symptoms worsened, with marked weight loss and suboclusion episodes. A right lower abdominal mass was found. Additional investigations (MRI enterography and colonoscopy) disclosed a diffuse large-cell B lymphoma. Immunosuppression was stopped and chemotherapy (R-CHOP) was started. Complete remission was achieved.

Palavras-chave : Crohn’s disease; Intestinal lymphoma; Immunosuppression; Methotrexate; Rheumatoid arthritis.

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