AI Article Synopsis
- - Patients with rheumatoid arthritis (RA) have a higher risk of developing malignant lymphoma compared to the general population, but primary central nervous system lymphoma (PCNSL) in RA patients is very rare; this study presents the first documented case of PCNSL in a patient treated with the bDMARD tocilizumab.
- - A 70-year-old man with a history of RA treated with low-dose methotrexate and later tocilizumab developed gait issues, leading to brain imaging that revealed lesions; a biopsy confirmed the diagnosis of PCNSL, which was successfully managed with chemotherapy.
- - There are concerns that treatments like low-dose methotrexate and bDMARDs may increase cancer risk in RA
Article Abstract
Background: Although the risk of developing malignant lymphoma is higher in patients with rheumatoid arthritis (RA) than in the general population, primary central nervous system lymphoma (PCNSL) in patients with RA is extremely rare. In recent years, there has been concern that biological disease-modifying antirheumatic drugs (bDMARDs), widely administered to patients with RA, might increase the risk of cancer development. The authors report the first case of PCNSL in a patient with RA receiving the bDMARD tocilizumab.
Observations: A 70-year-old man who was diagnosed with RA in 2010 was treated with low-dose methotrexate (MTX) from 2010 to 2015. Tocilizumab was commenced in 2012. In 2018, he developed gait disturbances, and gadolinium-enhanced magnetic resonance imaging showed multiple contrast-enhanced lesions in the basal ganglia and brain stem. Stereotactic brain biopsy led to the diagnosis of diffuse large B-cell lymphoma, and finally PCNSL was diagnosed. He was treated with five courses of MTX 3.5 g/m2, and his disease has been in remission for 34 months.
Lessons: Low-dose MTX and bDMARDs are associated with the concern of increased cancer risk in patients with RA. Because tocilizumab has been in use for a relatively short time, further accumulation of cases and careful follow-up are necessary.
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|---|---|
| http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9706331 | PMC |
| http://dx.doi.org/10.3171/CASE22256 | DOI Listing |
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