A case of T-cell dominant polymorphic methotrexate-associated lymphoproliferative disorder with peri-implantitis

Methotrexate related lymphoproliferative disorder is a lymphoma that occurs in the gingiva, buccal mucosa, and tongue as a consequence of long-term methotrexate administration, and its association with osteonecrosis of the jaws has also been reported. T-cell dominant polymorphic type is rare lymphoproliferative disorder; however, its association with peri-implantitis has not been reported. Here, we report a case of long-term methotrexate administration related T-cell dominant polymorphic lymphoproliferative disorder associated with peri-implantitis. An 80-year-old female patient with a chief complaint of swelling of the right mandibular mucosa around the implant was referred to our hospital for the treatment of intractable gingival ulcer. Intraoral view revealed bone exposure and ulcer in the lingual mucosa of mandibular implant. Biopsy was performed from gingival ulcer and polymorphic methotrexate related lymphoproliferative disorder was diagnosed. The patient recovered from the ulcer and pain after methotrexate withdrawal; however, bone exposure remained. Sequestrectomy was subsequently performed under local anesthesia. The patient showed no signs of recurrence 8 months after operation. Our report will shed light on the treatment and diagnosis of T-cell dominant polymorphic MTX-LPD. Further case studies and research may be needed to develop a better understanding of the disease.