Leflunomide-induced ILD: A rare and potentially fatal complication
DOI:
https://doi.org/10.15305/ijrci/v5i1/230Keywords:
leflunomide, Interstitial lung disease, rheumatoid arthritisAbstract
A 48-year-old male with rheumatoid arthritis (RA) developed acute respiratory failure 4 weeks after adding leflunomide to existing methotrexate therapy. On high-resolution computed tomography (HRCT) of thorax, the patient demonstrated dramatic improvement, with nearly complete resolution of lung infiltrates, after treatment with pulse steroids and cholestyramine washout. Leflunomide-induced interstitial lung disease (ILD) is a potentially fatal side effect that can be reversed with prompt management.
References
Picchianti Diamanti A, Markovic M, Argento G, Giovagnoli S, Ricci A, Laganà B, et al. Therapeutic management of patients with rheumatoid arthritis and associated interstitial lung disease: case report and literature review. Ther Adv Respir Dis. 2016 Dec;10(6):549-565.
Raj R, Nugent K. Leflunomide-induced interstitial lung disease (a systematic review). Sarcoidosis Vasc Diffuse Lung Dis. 2013; 30; 167-176.
Keng LT, Lin MW, Huang HN, Chung KP. Diffuse alveolar damage in a patient with rheumatoid arthritis under prolonged leflunomide treatment. A Case Report and Literature Review Medicine (Baltimore). 2016.
Singh JA, Saag KG, Bridges SL Jr, Akl EA, Bannuru RR, Sullivan MC. 2015 American College of Rheumatology Guideline for the Treatment of Rheumatoid Arthritis. Arth Care & Res2016; 68 :1–25.
Behrens F, Koehm M, Burkhardt H. Update 2011: Leflunomide in rheumatoid arthritis - strengths and weaknesses. Curr Opin Rheumatol. 2011;23:282-287.
Namba T, Tanaka KI, Ito Y, Hoshino T, Matoyama M, Yamakawa N. Induction of EMT-like phenotypes by an active metabolite of leflunomide and its contribution to pulmonary fibrosis. Cell Death Differ 2010;17:1882–95.
Sakai F, Noma S, Kurihara Y, Yamada H, Azuma A, Kudoh S, et al. Leflunomide-related lung injury in patients with rheumatoid arthritis: Imaging features. Mod Rheumatol 2005; 15:173-179.
Inokuma S, Sato T, Sagawa A, Matsuda T, Takemura T, Ohtsuka T, Saeki Yet al. Proposals for leflunomide use to avoid lung injury in patients with rheumatoid arthritis. Mod Rheumatol 2008;18:442–6.
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