J Korean Rheum Assoc.  2007 Sep;14(3):268-273. 10.4078/jkra.2007.14.3.268.

Successful Treatment of Interstitial Pneumonitis Induced by Leflunomide

• Sheen DH
• Lim MK
• Shim SC
• Lee SO
• Kang SW
• Song JK
• Lee YS

• KMID: 2202177
• DOI: http://doi.org/10.4078/jkra.2007.14.3.268

Abstract

Leflunomide is a disease-modifying antirheumatic drug that has been available in Korea since 2003. Leflunomide induced interstitial pneumonitis has been reported as an adverse effect in other countries but not in Korea. A 57-year-old woman was treated with leflunomide since she had been resistant to methotrexate, hydroxychloroquine and sulfasalazine. She developed high fever, dyspnea, and non-productive cough 3 months after the administration of leflunomide. She was diagnosed leflunomide-induced interstitial pneumonitis based on history, physical, laboratory, radiologic and pathologic findings. The patient was treated by prednisolone 1 mg/kg/day with cholestyramine 24 g/day, resulting in dramatic improvement. Here we report a case of leflunomide induced pneumonitis treated successfully with high dose steroid.

Keyword

Leflunomide; Interstitial pneumonitis; Rheumatoid arthritis

MeSH Terms

Arthritis, Rheumatoid
Cholestyramine Resin
Cough
Dyspnea
Female
Fever
Humans
Hydroxychloroquine
Korea
Lung Diseases, Interstitial*
Methotrexate
Middle Aged
Pneumonia
Prednisolone
Sulfasalazine
Cholestyramine Resin
Hydroxychloroquine
Methotrexate
Prednisolone
Sulfasalazine

Figure

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  Fig. 1. Chest CT on admission shows ground-glass opacity in her lower lung fields.

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  Fig. 2. Chest X ray shows diffuse infiltration on both lung fields (A), 15 days after follow-up chest X-ray reveals resolution of previously noted interstitial infiltration (B).

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  Fig. 3. Open lung biopsy shows focal interstitial lymphocytic infiltration without interstitial fibrosis, these findings suggest acute fibrinous and organizing pneumonia (H&E stain, ∗400).

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