Spontaneous remission of marginal zone B cell lymphoma in a patient with seropositive rheumatoid arthritis after discontinuation of infliximab-methotrexate treatment

A 64 year old female patient with seropositive rheumatoid arthritis (RA) diagnosed in 1997 was referred to our hospital in March 2002, because of high disease activity despite methotrexate (MTX)-sulfasalazine treatment. After exclusion of contraindications infliximab treatment in combination with MTX was started, with good response. At clinical control before the 16th infliximab infusion the patient reported problems with her sinuses. In a computed tomography (CT) scan of that region reactive lymphatic tissue was suspected. Because of the small size (3.5 to 2.8 cm) of the lesion, lymphoma or hypopharynx carcinoma was ruled out. Despite the benign features of the lesion a biopsy was performed, because of the increased risk of malignancy in RA1–3 during disease modifying antirheumatic drug (DMARD) treatment.4,5 Histopathological evaluation and immunohistochemistry led to the diagnosis of an …