Cutaneous lymphoma associated with Epstein-Barr virus infection in 2 patients treated with methotrexate

Whether patients with rheumatoid arthritis (RA) have an increased risk of d eveloping non-Hodgkin lymphoma is controversial, and opinions differ on the possible role of methotrexate in the occurrence of lymphomas in patients w ith RA. We report 1 T-cell lymphoma and 1 B-cell lymphoma restricted to the skin associated with Epstein-Barr virus infection that healed completely a nd spontaneously after discontinuation of methotrexate in a man with RA and a woman with dermatomyositis. Cutaneous infiltrating cells were infected b y a replicative form of Epstein-Barr virus. After discontinuation of methot rexate, the cutaneous lesions disappeared completely in 15 days without rec urrence. Discontinuation of methotrexate is necessary in patients with RA o r dermatomyositis who have a lymphoproliferative disorder, and a follow-up period of several weeks should be observed before specific therapy is initi ated.