Pulmonary abscess due to leflunomide use in rheumatoid arthritis: a case report.
A 43-year-old woman had rheumatoid arthritis (RA) for 5 years and complained of fever, arthralgia/myalgia, and night sweating for a month. She had been receiving only leflunomide (20 mg/day) for 5 months. On admission, there was no evidence of active arthritis or vasculitic lesion. Laboratory evaluation showed an erythrocyte sedimentation rate of 145 mm/h and C-reactive protein of 160 mg/dl. All cultures were negative. Chest radiograph and computed tomography (CT) revealed a pulmonary abscess. Staphylococcus aureus multiplied in the culture of a purulent sample obtained from the abscess under ultrasonography. The leflunomide was stopped, and sultamicillin (IV 4x2 g/day) was started for a further 6 weeks. Four weeks later, the patient had completely recovered and CT showed significant improvement of the pulmonary abscess. Ten milligrams/day of prednisolone and 7.5 mg/week of methotrexate were started for RA treatment. The patient has been under control for 5 months without any further abscess or RA activation.
Department of Physical Medicine and Rehabilitation, Medical Faculty, Ondokuzmayis University, 55139 Samsun, Turkey.
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Ulusoy
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Bilgici
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Kuru
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Celenk
D000328:Adult; D000667:Ampicillin / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D018501:Antirheumatic Agents / Q000009:adverse effects*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D005260:Female; D006801:Humans; D007555:Isoxazoles / Q000009:adverse effects*; D000077339:Leflunomide; D008169:Lung Abscess / Q000139:chemically induced / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000209:etiology*; D013407:Sulbactam / Q000627:therapeutic use; D014057:Tomography, X-Ray Computed
D000900:Anti-Bacterial Agents; D018501:Antirheumatic Agents; D007555:Isoxazoles; C035444:sultamicillin; D000667:Ampicillin; D000077339:Leflunomide; D013407:Sulbactam