Tuberc Respir Dis.  2009 Jun;66(6):477-481.

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

• Shin AY
• Kim SS
• Kim KH
• Ju IN
• Ko HJ

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 She recovered quickly after leflunomide was withdrawn and steroids and cholestyramine were initiated quickly.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.

Keyword

Leflunomide; Interstitial lung diseases; Rheumatoid arthritis

MeSH Terms

Adult
Arthritis, Rheumatoid
Cholestyramine Resin
Cough
Dyspnea
Female
Fever
Humans
Isoxazoles
Korea
Lung Diseases, Interstitial
Methotrexate
Physical Examination
Respiratory Insufficiency
Steroids
Cholestyramine Resin
Isoxazoles
Methotrexate
Steroids

Figure

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  Figure 1 (A) Chest X-ray shows diffuse infiltration and haziness on both lung fields. (B) At 3 days after treatment start, follow up chest X-ray shows resolution of previous infiltration and haziness.

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  Figure 2 Chest computed tomography imaging shows ground-glass opacity and consolidation in her both whole lung fields.

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