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- Title
Methotrexate-associated EBV-positive vasculitis in the skin: a report of two cases simulating rheumatoid vasculitis.
- Authors
Fujimoto, Masakazu; Kaku, Yo; Yamakawa, Noriyuki; Kawabata, Daisuke; Ohmura, Koichiro; Koyanagi, Itsuko; Mimori, Tsuneyo; Kabashima, Kenji; Haga, Hironori
- Abstract
Rheumatoid vasculitis ( RV) is one of the most serious extra-articular complications of rheumatoid arthritis ( RA), generally treated with a high dose of immunosuppressive drugs. Recently, we encountered two cases of ulcerative vasculitis in methotrexate ( MTX)-prescribed RA patients, which simulated RV; however, Epstein-Barr virus ( EBV)-encoded RNA in situ hybridization on their skin biopsies revealed many EBV-positive lymphocytes (over 50 cells/high-power field) within the vessel walls and perivascular stroma, which led us to the diagnosis of EBV-related vasculitis instead of RV. Subsequently, both ulcers regressed after the discontinuation of MTX and no recurrence was noted during the follow-up period. To prevent unnecessary treatment, EBV-positive vasculitis should be added in the differential diagnosis of lymphocytic vasculitis observed in MTX-administered RA patients.
- Subjects
RHEUMATOID arthritis; IMMUNOSUPPRESSIVE agents; METHOTREXATE; IN situ hybridization; LYMPHOCYTES
- Publication
Journal of Cutaneous Pathology, 2016, Vol 43, Issue 6, p520
- ISSN
0303-6987
- Publication type
Article
- DOI
10.1111/cup.12690