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はじめに
メトトレキサート(methotrexate:MTX)には副作用の1つにリンパ増殖性疾患(lymphoproliferative disorders:LPD)がある。今回,メトトレキサート関連リンパ増殖性疾患(methotrexate-associated lymphoproliferative disorders:MTX-LPD)に放線菌症を合併した1例を経験した。MTX-LPDの病因にはBリンパ球のEBウイルス(EBV)感染が示唆されており,EBV潜伏感染遺伝子の発現様式に基づく発症機序が報告されている1,2)。そこで本稿では,放線菌症の関与やLPDの発症予測を文献的に考察した。
A case of methotrexate-associated lymphoproliferative disorders(MTX-LPD)complicated by actinomycosis was reported. The tumor cells were B cell line with Epstein-Barr virus(EBV)infection. According to their expression pattern of the latent infection virogene, they were identified as latent infection type Ⅲ. Immunostaining of latent infection virogene(EBNA2, LMP1)and viral DNA assay can be a biomarker to predict the development of LPD. Actinomycosis is a cause of periodontal disease. Treatments of these complaints must contribute to the condition of rheumatoid arthritis and reduce the amount of MTX.
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