J Korean Geriatr Soc.  2014 Dec;18(4):232-236. 10.4235/jkgs.2014.18.4.232.

Pulmonary Cryptococcosis in Rheumatoid Arthritis Patient Treated With Leflunomide

• Byon CK
• Yim SW
• Park JY
• Roh MS
• Lee SW
• Chung WT
• Lee SY

• KMID: 2064153
• DOI: http://doi.org/10.4235/jkgs.2014.18.4.232

Abstract

Leflunomide, a disease-modifying antirheumatic drug, is effective for rheumatoid arthritis as monotherapy or combination therapy with methotrexate. The most common adverse effects are diarrhea, dyspepsia, nausea, abdominal pain, oral ulcer, hepatotoxicity, skin rash, hypertension, weight loss, and interstitial lung disease. The occurrence of pulmonary cryptococcosis in leflunomide treatment has not been reported in Korea. A 74-year-old woman was admitted to hospital due to asymptomatic pulmonary nodule. She was diagnosed rheumatoid arthritis and treated with leflunomide 5 months ago due to treatment failure with methotrexate, hydroxychloroquine, and sulfasalazine. Chest radiograph and computed tomography showed solitary pulmonary nodule in her right lower lung. Pulmonary cryptococcosis was confirmed by needle biopsy of lung stained with Gomori methenamine silver and mucicarmine. The lesion was improved after antifungal therapy for 3 months.

Keyword

Cryptococcosis; Leflunomide; Rheumatoid arthritis

MeSH Terms

Abdominal Pain
Aged
Arthritis, Rheumatoid*
Biopsy, Needle
Cryptococcosis*
Diarrhea
Dyspepsia
Exanthema
Female
Humans
Hydroxychloroquine
Hypertension
Korea
Lung
Lung Diseases, Interstitial
Methenamine
Methotrexate
Nausea
Oral Ulcer
Radiography, Thoracic
Solitary Pulmonary Nodule
Sulfasalazine
Treatment Failure
Weight Loss
Hydroxychloroquine
Methenamine
Methotrexate
Sulfasalazine