Purpose or Case Report: We present a case of an 11-year-old male with history of pars planitis (intermediate uveitis) on monthly infliximab and weekly methotrexate. The patient developed diffuse lymphadenopathy, predominantly in the head and neck region, raising suspicion for malignancy. CT of the neck and chest demonstrated enlarged cervical, upper mediastinal , and bilateral axillary lymph nodes. PET/CT confirmed prominent FDG uptake in these lymph nodes. A lymph node biopsy of a parotid lymph node confirmed Epstein Barr virus-positive polymorphic lymphoproliferative disorder in the setting of immune deficiency/dysregulation. Follow up PET/CT 2 months later after discontinuation of immunosuppressive therapy demonstrated significant improvement in size and radiotracer uptake of the enlarged lymph nodes. However within this time frame, the patient’s uveitis worsened. The patient is being followed by ophthalmology to explore other localized treatment options including steroid eye drops and steroid implants.
The majority of described findings in the radiology literature encompasses lymphoproliferative disorders in the setting of transplant (post-transplant lymphoproliferative disorder (PTLD)) or primary immunodeficiency. However, there is little in the way of lymphoproliferative disorders associated with immunosuppressive therapy. Most cases reported in the literature involve methotrexate use in adults with rheumatoid arthritis. Prior to 2022, this entity held a WHO classification entitled “other iatrogenic immunodeficiency-associated lymphoproliferative disorders (OII-LPD)”. Following a 2022 WHO reclassification, both PTLD and OII-LPD are encompassed under the classification of “lymphoid proliferations and lymphomas associated with immune deficiency and dysregulation". Further research on imaging of OII-LPD would add to the existing literature and increase awareness of such an entity in the setting of immunosuppressive therapy.
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