SHM Converge Scientific Abstract ePoster Gallery-Iatrogenic Immunodeficiency-Associated Lymphoproliferative Disorder in a Patient With Rheumatoid Arthritis

Pdf Summary

A 71-year-old woman with rheumatoid arthritis on chronic methotrexate presented with a month of fever, cough, weakness, and repeated hospital visits after being misdiagnosed with a prolonged influenza infection. Imaging eventually revealed bulky lymphadenopathy, and she developed new anemia, thrombocytopenia, elevated liver enzymes, and worsening kidney function.<br /><br />Her condition rapidly deteriorated with hypotension, hypoglycemia, and renal failure, requiring ICU transfer and hemodialysis. An axillary lymph node biopsy later confirmed iatrogenic immunodeficiency-associated lymphoproliferative disorder (IIALD), with elevated EBV DNA by PCR, suggesting reactivation of latent Epstein-Barr virus in the setting of methotrexate-induced immunosuppression.<br /><br />The case highlights that EBV-associated lymphoproliferative disease can present with nonspecific symptoms and mimic severe infections, lymphoma, HIV, sepsis, or hemophagocytic syndromes. Because the differential diagnosis is broad, lymph node biopsy is essential for confirmation.<br /><br />Due to severe organ dysfunction, the team chose treatment with weekly rituximab rather than simply stopping methotrexate and observing. After rituximab, the patient improved, with recovery in blood counts, kidney function, and liver enzymes.<br /><br />Key teaching points: maintain a high suspicion for lymphoproliferative disorder in immunosuppressed patients with fever, cytopenias, and lymphadenopathy; confirm diagnosis with biopsy; and consider early chemotherapy, especially rituximab, when there is significant organ damage.

Asset Subtitle

Belinda Lee

Meta Tag

Author List Belinda Lee

Category Clinical Vignettes

Concept Iatrogenic Immunodeficiency-Associated Lymphoproliferative Disorder

Concept Lymph Node Biopsy

Concept Rituximab

Concept Methotrexate

Concept Epstein-Barr Virus

Distinguished Non-Finalist

Presenter Organization Northwell Health

Presenting Author Belinda Lee

Track Adult

Keywords

methotrexate

rheumatoid arthritis

EBV reactivation

iatrogenic immunodeficiency-associated lymphoproliferative disorder

lymphadenopathy

cytopenias

rituximab

lymph node biopsy

immunosuppression

renal failure

Iatrogenic Immunodeficiency-Associated Lymphoproliferative Disorder

Lymph Node Biopsy

Rituximab

Methotrexate

Epstein-Barr Virus