October 4, 2025Open Access

Methotrexate-associated Lymphoproliferative Disorder Showing Colon and Liver Lesions Difficult to Distinguish from Colon Cancer with Liver Metastases: A Case Report

KKKazuya KanayaSeirei Hamamatsu General Hospital KKKensuke KitsugiSeirei Hamamatsu General Hospital KTK. Takahashi

Key Points

The patient experienced weight loss, and imaging initially suggested colon cancer with liver metastases, raising diagnostic challenges.
Histopathological analysis confirmed methotrexate-associated lymphoproliferative disorder as the diagnosis, leading to treatment changes.
Lesions improved significantly following the discontinuation of methotrexate, showcasing the potential reversibility of this condition.
This case highlights the importance of considering methotrexate-associated lymphoproliferative disorder in patients with gastrointestinal symptoms on MTX therapy.

Abstract

An 82-year-old man presented with weight loss was being treated with methotrexate (MTX) for rheumatoid arthritis. Computed tomography revealed sigmoid colonic wall thickening and multiple liver masses. Although we initially considered sigmoid colon cancer with liver metastases, the patient was diagnosed with MTX-associated lymphoproliferative disorder (MTX-LPD) based on histopathological findings and clinical course. All the lesions improved after MTX discontinuation. MTX-LPD rarely affects the gastrointestinal tract, particularly the colon. However, our case suggests that MTX-LPDs should be considered when gastrointestinal lesions are observed in patients receiving MTX.

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