Methotrexate-related lymphoproliferative disorder of the lumbar spine origin presenting with severe low-back pain: case report

J Neurosurg Spine. 2018 Nov 1;29(5):545-548. doi: 10.3171/2018.4.SPINE1860.


The use of methotrexate (MTX) to treat rheumatoid arthritis (RA) is increasing. Recently, MTX-associated lymphoproliferative disorder (MTX-LPD) has been frequently reported as lymphoma occurring during MTX therapy. The authors report their experience with a relatively rare case of MTX-LPD presenting in the lumbar spine. The patient, a 73-year-old woman who experienced low-back pain while receiving MTX therapy for RA, was suspected of having developed MTX-LPD based on her medical history, images of the L1 vertebra, and transpedicular biopsy results. One week after discontinuing MTX, the patient's low-back pain reportedly improved. The woman was diagnosed with MTX-LPD based on histopathological findings. MTX discontinuation alone coincided with spontaneous tumor regression. Because MTX-LPD can occur in tissues other than lymph nodes, such as in bones and joints, it is a disease that should be considered when diagnosing spinal tumors in patients receiving MTX therapy.

Keywords: EBV = Epstein-Barr virus; LPD = lymphoproliferative disorder; MTX = methotrexate; MTX-LPD = MTX-associated LPD; RA = rheumatoid arthritis; lumbar spine; lymphoproliferative disorder; methotrexate; oncology; rheumatoid arthritis.

Publication types

  • Case Reports

MeSH terms

  • Aged
  • Arthritis, Rheumatoid / complications
  • Arthritis, Rheumatoid / drug therapy
  • Back Pain / complications
  • Back Pain / diagnosis
  • Back Pain / economics*
  • Female
  • Humans
  • Lumbar Vertebrae / drug effects
  • Lumbosacral Region / surgery
  • Lymphoproliferative Disorders / drug therapy*
  • Methotrexate / adverse effects
  • Methotrexate / therapeutic use*
  • Spinal Neoplasms / diagnosis
  • Spinal Neoplasms / drug therapy*


  • Methotrexate