Case Report
Ghasoub R, Taha R, Tlemat A
Abstract
Introduction: Lymphoma association with Rheumatoid Arthritis (RA) is well established. The mechanisms behind this association remain a matter of controversy. Objective: We here report a patient with rheumatoid arthritis who developed peripheral T-cell lymphoma not otherwise specified following etanercept (TNF-alpha inhibitor) and methotrexate therapy. Clinical Presentation: A 38-year-old female presented to emergency with history of fever and cough for 2 weeks. The patient’s medical history revealed that she had seronegative RA for 3 years. The patient had started initially on Methotrexate then she was switched to etanercept for 3 years. Initial workup done in emergency showed pancytopenia; right axillary inguinal lymphadenopathy and splenomegaly by computerized tomography scan. Lymph node excisional biopsy was consistent with peripheral T-cell lymphoma not otherwise specified stage IIIB. Conclusion: Due to the pre-existent severe RA disease and prior methotrexate administration, it is difficult to establish a clear relationship between etanercept and the development of lymphoma in our case. Long term followup of patients with RA who are on anti TNF blockers is recommended.