title: Pulmonary alveolar proteinosis associated with a disease-modifying antirheumatoid arthritis drug.
abstract: Pulmonary alveolar proteinosis is an uncommon disorder marked by the abnormal accumulation of surfactant within the alveoli. Secondary pulmonary alveolar proteinosis develops in patients who are immunosuppressed, usually with corticosteroids. We present a case of biopsy-proven pulmonary alveolar proteinosis in a patient undergoing therapy with the disease-modifying antirheumatoid arthritis drug leflunomide (Arava; Aventis Pharmaceuticals, Bridgewater, NJ). He was treated with whole lung lavage and discontinuation of leflunomide with good results. This is the first reported association of secondary pulmonary alveolar proteinosis with leflunomide therapy. Pulmonary alveolar proteinosis should be considered in patients with diffuse lung disease that develops while on disease-modifying antirheumatoid arthritis drug therapy.
authors.affiliation: Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine, Vanderbilt University, T1218 Medical Center North, 1161 21st Avenue Nashville, TN 37232-2650, USA.
authors.forename: Noel R
authors.initials: NR
authors.lastname: Wardwell
authors.forename: Robert
authors.initials: R
authors.lastname: Miller
authors.forename: Lorraine B
authors.initials: LB
authors.lastname: Ware
mesh_terms: D000328:Adult; D018501:Antirheumatic Agents / Q000009:adverse effects*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy; D006801:Humans; D007555:Isoxazoles / Q000009:adverse effects*; D000077339:Leflunomide; D008297:Male; D011649:Pulmonary Alveolar Proteinosis / Q000139:chemically induced* / Q000175:diagnosis / Q000628:therapy
chemical_list: D018501:Antirheumatic Agents; D007555:Isoxazoles; D000077339:Leflunomide