title: Leflunomide induced acute interstitial pneumonia.
abstract: We describe a 54-year-old woman with rheumatoid arthritis (RA), who developed acute respiratory failure 2 weeks after cessation of 6-week treatment with leflunomide. We diagnosed interstitial pneumonia, probably induced by leflunomide because acute respiratory failure was preceded by elevated serum liver enzyme concentration and hypertension. She showed dramatic improvement with prednisolone and cholestyramine. Prompt treatment may improve the prognosis. In Japan, leflunomide has been implicated as a possible cause to initiate or exacerbate interstitial pneumonia in patients with RA according to postmarketing surveillance. Clinicians should exclude pulmonary disease prior to initiating leflunomide treatment in patients with RA on the basis of a thorough history and physical examination, and chest radiograph.
authors.affiliation: Division of Rheumatology, Saitama Medical School, Saitama, Japan. mtakeish@saitama-med.ac.jp
authors.forename: Michio
authors.initials: M
authors.lastname: Takeishi
authors.forename: Yuji
authors.initials: Y
authors.lastname: Akiyama
authors.forename: Haruhiko
authors.initials: H
authors.lastname: Akiba
authors.forename: Daisuke
authors.initials: D
authors.lastname: Adachi
authors.forename: Motoharu
authors.initials: M
authors.lastname: Hirano
authors.forename: Toshihide
authors.initials: T
authors.lastname: Mimura
mesh_terms: D000276:Adjuvants, Immunologic / Q000009:adverse effects*; D001172:Arthritis, Rheumatoid / Q000150:complications* / Q000188:drug therapy; D002792:Cholestyramine Resin / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007555:Isoxazoles / Q000009:adverse effects*; D000077339:Leflunomide; D017563:Lung Diseases, Interstitial / Q000139:chemically induced* / Q000188:drug therapy / Q000473:pathology; D008875:Middle Aged; D011239:Prednisolone / Q000627:therapeutic use; D013902:Radiography, Thoracic; D016896:Treatment Outcome
chemical_list: D000276:Adjuvants, Immunologic; D007555:Isoxazoles; D002792:Cholestyramine Resin; D011239:Prednisolone; D000077339:Leflunomide