Atypical methotrexate ulcerative stomatitis with features of lymphoproliferative like disorder: report of a rare ciprofloxacin-induced case and review of the literature

• Nikolaos Katsoulas ^[1] ; Evanthia Chrysomali ^[1] ; Evangelia Piperi ^[1] ; Georgia Levidou ^[1] ; Alexandra Sklavounou-Andrikopoulou ^[1]
  1. [1] National and Kapodistrian University of Athens

     National and Kapodistrian University of Athens

     Dimos Athens, Grecia

     
• Localización: Journal of Clinical and Experimental Dentistry, ISSN-e 1989-5488, Vol. 8, Nº. 5 (Diciembre), 2016, págs. 629-633
• Idioma: inglés
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• Resumen

  • Methotrexate (MTX) is an established immunomodulating agent used in low doses (LDMTX) to treat several autoimmune diseases. Ulcerative stomatitis (US) may be observed as a long-term LDMTX adverse effect showing a wide histopathologic spectrum. A 73-year old female presented with painful oral ulcers of 5 days duration. The patient had been under treatment for rheumatoid arthritis with LDMTX, while one week before presentation she was prescribed ciprofloxacin for a urinary infection. Histopathologic examination of a lingual ulcer revealed a polymorphous lymphohistiocytic proliferation with scattered binucleated atypical lymphocytes. Immunohistochemically, most cells were of T-cell lineage while the EBER test was negative and a diagnosis of MTX-induced reactive ulceration was rendered. MTX cessation resulted in complete resolution of the ulcers with no recurrences reported so far. The clinical and histopathologic features of MTX-induced oral ulcers are not always diagnostic and a detailed history and an extensive clinicopathologic investigation may be needed to exclude a lymphoproliferative disorder.