Reversible methotrexate associated lymphoproliferative disease evolving into Hodgkin's disease

We describe a case of nodular sclerosing Hodgkin's disease (NSHD) developin g in a 61-year-old woman with seropositive rheumatoid arthritis treated wit h oral methotrexate (MTX) 5 to 15 mg/week for 5 veers. Computed tomography (CT) of the abdomen revealed splenomegaly and marked abdominal and retroper itoneal lymphadenopathy. MTX was discontinued; several weeks later predniso ne 10 mg/day was added to control worsening polyarthralgia. Repeat CT at 3 months showed almost complete regression of the splenomegaly and lymphadeno pathy. However, CT studies at 10 months showed asymptomatic progression of lymphadenopathy, which on biopsy revealed NSHD. Patients with apparently re versible MTX associated lymphoproliferative disorder require periodic monit oring for asymptomatic development of malignant lymphoma.