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May 2013 pulmonary case of the month: the cure can be worse than the disease

Keywords: dermatomyositis , methotrexate , lymphoma , Epstein-Barr virus , Reed-Sternberg cells , lymphoproliferative disease , immunodeficiency-related lymphoproliferative disease , methotrexate-associated lymphoproliferative disease

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Abstract:

No abstract available. Article truncated after 150 words. History of Present Illness A 65 year old man from Colorado presented for evaluation of “lung masses.” He had a prior diagnosis of dermatomyositis made in 2010 and had been with intravenous immunoglobulin (IVIG), prednisone and methotrexate. He had been previously seen in January, 2011 with a 5 mm left lower lobe nodule on thoracic CT which was unchanged compared to August, 2010. A thoracic CT scan done in July, 2011 in Colorado was interpreted as stable. Over the prior month had been having chest discomfort. He had a history of pulmonary embolism (PE) and felt the pain was similar in quality to his prior PE. This prompted a chest x-ray and he was told of “lung masses”. He had also experienced 20 pound weight loss. His current medications included methotrexate 25 mg weekly, prednisone 3 mg every other day and warfarin 7 mg daily. PMH, SH, FH In addition …

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