Methotrexate-Associated Lymphoproliferative Disorder Presenting as Obstructive Jaundice Due to Pancreatic Involvement

Intern Med. 2025 Dec 1;64(23):3387-3394. doi: 10.2169/internalmedicine.5609-25. Epub 2025 May 29.

Abstract

A 73-year-old man with a 13-year history of methotrexate (MTX) therapy for rheumatoid arthritis presented with jaundice and hepatic dysfunction. Contrast-enhanced computed tomography revealed hypovascular masses in the pancreas, small intestine, and thyroid lobes. A biopsy confirmed diffuse large B-cell lymphoma (DLBCL), leading to the diagnosis of MTX-associated lymphoproliferative disorder (MTX-LPD), a rare condition with pancreatic involvement. MTX was discontinued and R-CHOP therapy was initiated. Although a spontaneous regression of MTX-LPD can occur, early intervention may be warranted in select cases, thus highlighting the need for an individualized management approach.

Keywords: lymphoma; lymphoproliferative disorders; methotrexate; pancreas.

Publication types

  • Case Reports

MeSH terms

  • Aged
  • Antineoplastic Combined Chemotherapy Protocols / therapeutic use
  • Antirheumatic Agents* / adverse effects
  • Arthritis, Rheumatoid / drug therapy
  • Cyclophosphamide / therapeutic use
  • Doxorubicin / therapeutic use
  • Humans
  • Jaundice, Obstructive* / diagnosis
  • Jaundice, Obstructive* / etiology
  • Lymphoma, Large B-Cell, Diffuse* / chemically induced
  • Lymphoma, Large B-Cell, Diffuse* / complications
  • Lymphoma, Large B-Cell, Diffuse* / diagnosis
  • Lymphoma, Large B-Cell, Diffuse* / drug therapy
  • Lymphoproliferative Disorders* / chemically induced
  • Lymphoproliferative Disorders* / complications
  • Lymphoproliferative Disorders* / diagnosis
  • Male
  • Methotrexate* / adverse effects
  • Prednisone / therapeutic use
  • Rituximab
  • Vincristine / therapeutic use

Substances

  • Methotrexate
  • Rituximab
  • Antirheumatic Agents
  • Cyclophosphamide
  • Vincristine
  • R-CHOP protocol
  • Doxorubicin
  • Prednisone