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Spontaneous remission of methotrexateassociated lymphoproliferative disorder with Epstein-Barr virus type II latency

Methotrexate (MTX), an antimetabolite of folic acid, is an immunosuppressive agent that has been used as an anchor drug for the treatment of rheumatoid arthritis (RA). One of the many severe adverse effects of MTX is lymphoproliferative disorder (LPD). Here, we describe a case of MTX-associated LPD (MTX-LPD) that manifested as skin ulcers mimicking venous leg ulcers. An 80-year-old woman presented with a one-month history of erosive erythema and oedema on her lower leg. From the age of 50 to 73 years, she received systemic prednisolone (5 mg/day) for systemic sclerosis (SSc) and MTX (6 mg/week) for RA. Physical examination revealed two erosive erythematous lesions measuring 10 mm in diameter on her left lower leg (figure 1A). An oral antithrom-