Spontaneous Regression of a Retinal Mass With Epstein-Barr Virus-Positive and Cytomegalovirus-Positive Panuveitis in Methotrexate-Associated Lymphoproliferative Disorder

Methotrexate (MTX) has been widely used for patients with autoimmune diseases as a corticosteroid-sparing agent. We here report an 86-year-old Japanese woman treated with MTX for rheumatoid arthritis who presented with panuveitis along with a yellowish retinal mass. Both Epstein-Barr virus (EBV) and cytomegalovirus (CMV) were detected in aqueous humor and vitreous fluid by quantitative polymerase chain reaction. The retinal mass gradually regressed over eight months after MTX withdrawal. The present case indicates that intraocular MTX-lymphoproliferative disorder (MTX-LPD) should be considered in the differential diagnosis of patients presenting with uveitis who are undertaking long-term MTX therapy. Multiplex PCR along with quantitative PCR for intraocular fluids may be helpful for understanding the pathogenesis of intraocular MTX-LPD.