Background: It is necessary to pay attention to the development of opportunistic infections and malignant diseases while receiving methotrexate (MTX). In this study, we report a case of intraocular malignant lymphoma that developed after treatment of cytomegalovirus (CMV) retinitis while taking MTX.
Case: A 73-year-old woman was referred to our hospital for examination and treatment of uveitis in her left eye. The best corrected visual acuity in her left eye was 0.3. Mutton fat keratic precipitates (KP), moderate vitreous flares, and many white exudates on the peripheral retina were observed. She was taking 14 mg of MTX for rheumatoid arthritis. CMV was detected by anterior aqueous humor polymerase chain reaction (PCR) test, leading to a diagnosis of CMV retinitis. It was cured after antiviral treatment. However, 3 years later, blurred vision developed in her left eye, along with recurrence of mutton fat KP, hypopyon, significant vitreous flare, and multiple white exudates from the posterior pole to periphery. Cytology was performed by collecting cells in the eye, indicating a large number of malignant lymphocytes. This condition was diagnosed as intraocular malignant lymphoma, and the patient underwent systemic chemotherapy and intraocular MTX injection. The condition improved and the post-treatment course is good.
Conclusions: In this case, long-term oral MTX treatment caused immune abnormalities, which induced CMV retinitis and intraocular lymphoma. In case of long-term MTX administration, attention should be paid to both opportunistic infections and malignant diseases.
Nippon Ganka Gakkai Zasshi (J Jpn Ophthalmol Soc) 128: 431-439, 2024.