Methotrexate-Associated Lymphoproliferative Disorder Presenting as Obstructive Jaundice Due to Pancreatic Involvement.

A 73-year-old man with a 13-year history of methotrexate (MTX) therapy for rheumatoid arthritis presented with jaundice and hepatic dysfunction. Contrast-enhanced computed tomography revealed hypovascular masses in the pancreas, small intestine, and thyroid lobes. A biopsy confirmed diffuse large B-cell lymphoma (DLBCL), leading to the diagnosis of MTX-associated lymphoproliferative disorder (MTX-LPD), a rare condition with pancreatic involvement. MTX was discontinued and R-CHOP therapy was initiated. Although a spontaneous regression of MTX-LPD can occur, early intervention may be warranted in select cases, thus highlighting the need for an individualized management approach.