Research Day
T-CELL LARGE GRANULAR LYMPHOCYTE LEUKEMIA DURING TREATMENT WITH METHOTREXATE FOR RHEUMATOID ARTHRITIS - A CASE STUDY
Document Type
Abstract
Date
2021
Abstract
Case report: 70-year-old female with a long-term history of rheumatoid arthritis and psoriasis presented to rheumatology office for assessment. She had been off any medications for the past 2 years, after using methotrexate for many years previously, and stated her symptoms were worsening. Patient was started on methotrexate; her initial CBC was unremarkable except for mild thrombocytopenia (125-10*9/L). She showed clinical improvement, however subsequent CBC showed platelets of 103-10*9/L and absolute neutrophil count of 0.1-10*9/L; methotrexate was held. A blood smear was obtained which showed absolute lymphocytosis with increase in large granular lymphocytes (LGLs). Peripheral blood flow cytometry suggested the diagnosis of T-cell granular lymphocytic leukemia (T-LGLL) and bone marrow biopsy confirmed the diagnosis, with findings of a hypercellular marrow with a discrete monoclonal CD8+ lymphocyte population which did not express CD4 or T-cell receptor. Patient was started on cyclosporine and G-CSF since she had no response while taking methotrexate for autoimmune disease. Patient achieved stability in both clinical symptoms and cell counts after treatment.
Discussion: LGL leukemia is a rare indolent lymphoproliferative disease first described in 1985 as a process including blood, marrow and spleen. It is classically associated with autoimmune disorders, specifically rheumatoid arthritis, which is present in 11-36% of patients with LGLL. Neutropenia is a common finding in T-LGLL, and opportunistic infections are usually the reason patients seek medical attention. In our case, the patient had T-LGLL as an incidental finding while undergoing treatment with methotrexate, which is first-line therapy for this condition.