CTICasesMethotrexate-Induced Iatrogenic Immunodeficiency-Associated Lymphoproliferative Disorder
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Imaging findings
Initial chest radiograph and CT scan show bilateral, extensive mediastinal and hilar lymphadenopathy alongside multiple, ill-defined, bilateral nodular pulmonary opacities that are predominantly bronchocentric in distribution. Intra-abdominal lymphadenopathy is also present near the gastroesophageal junction and retroperitoneum. Following discontinuation of the offending agent, a follow-up CT scan demonstrates rapid and substantial spontaneous resolution of both the lymphadenopathy and the bronchocentric pulmonary nodules without any targeted oncologic therapy.
Key takeaways
Iatrogenic immunodeficiency-associated lymphoproliferative disorder (LPD) is a rare, polyclonal proliferative process that can occur in patients receiving immunosuppressive drugs, such as methotrexate for psoriasis or inflammatory bowel disease. It is often driven by Epstein-Barr virus replication. The defining clinical feature of this condition is its potential for rapid, complete, and spontaneous resolution once the immunosuppressive therapy is withdrawn.
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