Remission of chronic type ATL in a patient with rheumatoid arthritis after withdrawing methotrexate and infliximab combination therapy: a case report. Issue 1 (2nd January 2018)

• Record Type: Journal Article
• Authors: Hashiba, Yayoi; Hidaka, Toshihiko; Umekita, Kunihiko; Nishi, Eiko; Kai, Yasufumi; Kubo, Kazuyoshi; Okayama, Akihiko
• Is Part Of: Modern rheumatology case reports. Volume 2:Issue 1(2018)
• Page Start: 9
• Page End: 13
• Publication Date: 2018-01-02
• Subjects: Rheumatoid arthritis -- human T-lymphotropic virus type 1 -- adult T-cell leukaemia/lymphoma -- disease modifying anti-rheumatic drugs; Rheumatology -- Periodicals; 616.723005
• DOI: 10.1080/24725625.2017.1372060
• Languages: English
• ISSNs: 2472-5625

Abstract

Abstract: A 70-year-old Japanese female was diagnosed with seropositive rheumatoid arthritis (RA) in January 2008. She had high disease activity and was treated with prednisolone, methotrexate (MTX) and infliximab (IFX). She was found to be positive for human T-lymphotropic virus type 1 (HTLV-1) antibody in 2012, and her HTLV-1 proviral DNA load (PVL) was as high as 5.82 copies per 100 white blood cells (WBCs). In 2014, she complained of fever and showed elevated soluble IL-2 receptors (sIL-2R) and WBCs. Abnormal lymphocytes with convoluted nuclei were found on blood smear analysis (13% of WBCs). She was negative for lymphadenopathy, skin lesion and organomegaly. She was diagnosed with chronic type adult T-cell leukaemia-lymphoma (ATL), and treatment with IFX and MTX was discontinued. Abnormal lymphocytes disappeared and sIL-2R level decreased a few months later. ATL did not relapse for more than 2 years. This case emphasises the need for careful observation in HTLV-1 positive patients with RA, especially in patients with high PVL. In addition, there is a possibility that prompt withdraw of biologics and MTX may contribute to the spontaneous remission of ATL.