Mitral and Aortic Valve Regurgitation Caused by Methotrexate-Associated Lymphoproliferative Disorder
- VernacularTitle:メトトレキサート関連リンパ増殖性疾患による僧帽弁閉鎖不全症・大動脈弁閉鎖不全症の1例
- Author:
Yosuke SUGITA
1
;
Hiroyuki HARA
1
;
Keita YANO
1
;
Shinya TAKIMOTO
1
;
Naoki KANEMITSU
1
Author Information
- Keywords: methotrexate-associated lymphoproliferative disorder; aseptic endocarditis; aortic valve regurgitation; mitral valve regurgitation
- From:Japanese Journal of Cardiovascular Surgery 2024;53(4):183-187
- CountryJapan
- Language:Japanese
- Abstract: We report on a rare case of valvular regurgitation caused by methotrexate-associated lymphoproliferative disorder (MTX-LPD). A 60-year-old woman was on methotrexate (MTX) for rheumatoid arthritis. She had developed ulcerative lesions on her extremities, which were diagnosed as lymphoproliferative disorder (LPD) by skin biopsy. She had small intestinal perforation during the same time period, and underwent partial bowel resection. MTX was withdrawn perioperatively. The patient experienced congestive heart failure immediately after the operation and was diagnosed with severe mitral valve regurgitation and moderate-to-severe aortic valve regurgitation. She underwent mitral valve plasty and aortic valve replacement. We observed mitral valve perforation, surrounded by a cauliflower-shaped elevation. Meanwhile, the aortic valve leaflets degenerated into cauliflower-like structures. Pathological findings suggested infiltration of B lymphocytes and Epstein–Barr virus infection in the valve tissue. These findings were similar to those of the prior skin ulcer diagnosed as LPD, which healed spontaneously after MTX withdrawal. She was diagnosed with MTX-LPD based on the pathological findings and clinical history. The patient was discharged on postoperative day 19.
