바로가기메뉴

본문 바로가기 주메뉴 바로가기

Tuberculosis & Respiratory Diseases

Article Contents

Prev Next
e-Submission

Vol.66 No.6
Citation Share

A Case of Interstitial Pneumonitis in a Patient with Rheumatoid Arthritis Treated with Leflunomide

Tuberculosis & Respiratory Diseases / Tuberculosis & Respiratory Diseases,
2009, v.66 no.6, pp.477-481





& (2009). A Case of Interstitial Pneumonitis in a Patient with Rheumatoid Arthritis Treated with Leflunomide. Tuberculosis & Respiratory Diseases, 66(6), 477-481.
  • Downloaded
  • Viewed
PDF Download

Abstract

Leflunomide, a disease-modifying antirheumatic drug (DMARD) for the treatment of rheumatoid arthritis has been available in Korea since 2003. Leflunomide-associated interstitial pneumonitis has been appearing recently. A 25-year-old woman with a 12-month history of seronegative rheumatoid arthritis (RA) presented with acute respiratory insufficiency. She developed fever, dyspnea, and non-productive cough. Her medication history included methotrexate (15 mg/week. commencing 1 year prior) and leflunomide (20 mg/day, no loading dose, commencing 4 months prior). She was diagnosed with leflunomide-associated interstitial pneumonitis based on history, physical examination, laboratory and radiologic findings. She recovered quickly after leflunomide was withdrawn and steroids and cholestyramine were initiated quickly. We report a case of leflunomide-associated interstitial pneumonitis treated successfully with intravenous high-dose steroid and cholestyramine.

keywords
Leflunomide, Interstitial lung diseases, Rheumatoid arthritis

Reference

1.

Park YB, Lee SK. Leflunomide: a new disease modifying anti-rheumatic drug. J Korean Rheum Assoc 2000;7:323-32.

2.

Kalden JR, Schattenkirchner M, Sörensen H, Emery P, Deighton C, Rozman B, et al. The efficacy and safety of leflunomide in patients with active rheumatoid arthritis: a five-year followup study. Arthritis Rheum 2003;48:1513-20.

3.

Chikura B, Lane S, Dawson JK. Clinical expression of leflunomide-induced pneumonitis. Rheumatology (Oxford). Forthcoming 2009.

4.

Savage RL, Highton J, Boyd IW, Chapman P. Pneumonitis associated with leflunomide: a profile of New Zealand and Australian reports. Intern Med J 2006;36:162-9.

5.

Lee JH, Cheon WS, Seo YI, Eom KS, Jang SH, Bahn JW, et al. A case of interstitial pneumonitis caused by leflunomide. Tuberc Respir Dis 2005;58:83-8.

6.

Sheen DH, Lim MK, Shim SC, Lee SO, Kang SW, Song JK, et al. Successful treatment of interstitial pneumonitis induced by leflunomide. J Korean Rheum Assoc 2007;14:268-73.

7.

Breedveld FC, Dayer JM. Leflunomide: mode of action in the treatment of rheumatoid arthritis. Ann Rheum Dis 2000;59:841-9.

8.

Bartlett RR, Brendel S, Zielinski T, Schorlemmer HU. Leflunomide, an immunorestoring drug for the therapy of autoimmune disorders, especially rheumatoid arthritis. Transplant Proc 1996;28:3074-8.

9.

McCurry J. Japan deaths spark concerns over arthritis drug. Lancet 2004;363:461.

10.

Searles G, McKendry RJ. Methotrexate pneumonitis in rheumatoid arthritis: potential risk factors. Four case reports and a review of the literature. J Rheumatol 1987;14:1164-71.

11.

Suissa S, Hudson M, Ernst P. Leflunomide use and the risk of interstitial lung disease in rheumatoid arthritis. Arthritis Rheum 2006;54:1435-9.

12.

Kremer J, Genovese M, Cannon GW, Caldwell J, Cush J, Furst DE, et al. Combination leflunomide and methotrexate (MTX) therapy for patients with active rheumatoid arthritis failing MTX monotherapy: open-label extension of a randomized, double-blind, placebo controlled trial. J Rheumatol 2004;31:1521-31.

13.

Vallbracht II, Popper HH, Rieber J, Nowak F, Gallenberger S, Piper B, et al. Lethal pneumonitis under leflunomide therapy. Rheumatology (Oxford) 2005;44:1580-1.

14.

Chikura B, Sathi N, Lane S, Dawson JK. Variation of immunological response in methotrexate-induced pneumonitis. Rheumatology (Oxford) 2008;47:1647-50.

Tuberculosis & Respiratory Diseases

e-Submission OA Policy