Lymphoma in a patient with rheumatoid arthritis receiving methotrexate treatment: successful treatment with rituximab

A 55 year old man with chronic lymphocytic leukaemia (CLL) and rheumatoid a rthritis (RA), treated for four years with methotrexate (MTX), who develope d a B cell non-Hodgkin's lymphoma (B-NHL), is described. The tumour was loc alised to the shoulder and axillary lymph nodes, and positive for Epstein-B arr viral antigens. After failure of radiation and chemotherapy, a complete remission was achieved with a combination of antibody treatment (rituximab ) and EPOCH. The development of a second malignancy in a patient with RA re ceiving MTX has not been described before. The summation of T cell deficien cies induced by MTX, CLL, and RA may all have contributed to the developmen t of the B-NHL.