@article{2990727,
    title = "Atypical methotrexate ulcerative stomatitis with features of lymphoproliferative like disorder: Report of a rare ciprofloxacin-induced case and review of the literature",
    author = "Katsoulas, N. and Chrysomali, E. and Piperi, E. and Levidou, G. and Sklavounou-Andrikopoulou, A.",
    journal = "Journal of Clinical and Experimental Dentistry",
    year = "2016",
    volume = "8",
    number = "5",
    pages = "e629-e633",
    publisher = "Medicina Oral S.L.",
    doi = "10.4317/jced.52909",
    abstract = "Methotrexate (MTX) is an established immunomodulating agent used in low doses (LDMTX) to treat several autoimmune diseases. Ulcerative stomatitis (US) may be observed as a long-term LDMTX adverse effect showing a wide histopathologic spectrum. A 73-year old female presented with painful oral ulcers of 5 days duration. The patient had been under treatment for rheumatoid arthritis with LDMTX, while one week before presentation she was prescribed ciprofloxacin for a urinary infection. Histopathologic examination of a lingual ulcer revealed a polymorphous lymphohistiocytic proliferation with scattered binucleated atypical lymphocytes. Immunohistochemically, most cells were of T-cell lineage while the EBER test was negative and a diagnosis of MTX-induced reactive ulceration was rendered. MTX cessation resulted in complete resolution of the ulcers with no recurrences reported so far. The clinical and histopathologic features of MTX-induced oral ulcers are not always diagnostic and a detailed history and an extensive clinicopathologic investigation may be needed to exclude a lymphoproliferative disorder. © Medicina Oral S. L. C.I.F. B 96689336."
}