Epstein-Barr virus-associated Hodgkin's lymphoma and Legionella pneumophila infection complicating treatment of juvenile rheumatoid arthritis with methotrexate and cyclosporine A

We describe the case of a 53-month-old girl with juvenile rheumatoid arthri tis (JRA), complicated by the occurrence of Hodgkin's lymphoma and Legionel la pneumophila infection during immunosuppressive treatment with methotrexa te (MTX) and cyclosporine A (CSA). The girl had received variable anti-infl ammatory combination therapy, including MTX for 28 months and CSA for 3 mon ths. Thirty-six months after the onset of arthritis, the girl presented wit h an enlargement of the lymph nodes of the mediastinum, the hilum of the lu ngs, and the abdomen. Concomitantly, a diagnosis of Legionella pneumonia wa s rendered. Autopsy showed Epstein-Barr virus (EBV)-associated nodular scle rosing Hodgkin's lymphoma. The neoplastic cells were positive for CD15, CD 30, and latent membrane protein I (LMP 1). The present case is the second r eported to occur in a child, and it lends support to the hypothesis that im munosuppressive treatment may contribute to an increased risk of the develo pment of EBV-associated lymphoproliferative disorders (LPD) in pediatric pa tients suffering from JRA. Copyright (C) 2000 by W.B. Saunders Company.