Methotrexate
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Acute rheumatoid nodulosis in liver and spleen: case report An 80-year-old woman developed acute rheumatoid nodulosis in the liver and spleen during treatment with methotrexate for rheumatoid arthritis. The woman presented to hospital with a 3-month history of progressive weight loss, fatigue and fever. She also had a history of rheumatoid arthritis, for which she was taking methylprednisolone 4 mg/d and methotrexate [route and dosage not stated] for the previous 13 years. On admission, a CT scan revealed different-sized hypodense lesions in the liver and spleen parenchyma. The same CT scan at a different level showed the presence of a mass in the portal vein, head of the pancreas and anterior to the inferior vena cava with abdominal lymphadenopathy [duration of the treatment to reaction onset not stated]. Methotrexate was discontinued, and the woman started receiving a double dose of methylprednisolone. Her temperature decreased on day 5, and her general health condition improved. Microscopic examination revealed that the liver was occupied by rheumatoid-like nodules with a necrotic centre, infused with fibrin and surrounded by lymphocytes. Two months later, a repeat CT scan showed a significant decrease in the liver and spleen lesions and complete disappearance of intra-abdominal lymph nodes. Kosmidou M, et al. Methotrexate-Induced Acute Rheumatoid Nodulosis in Liver and Spleen Imitating Metastatic Malignancy. JCR: Journal of Clinical Rheumatology : 20 803502507 Aug 2020. Available from: URL: http://doi.org/10.1097/RHU.0000000000001519
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Reactions 26 Sep 2020 No. 1823
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