title: Leflunomide-related lung injury in patients with rheumatoid arthritis: imaging features.
abstract: Imaging findings of 26 cases of leflunomide (Arava)-related acute lung injury were analyzed. Thirteen cases had pre-existing interstitial pulmonary disease on chest X-ray or computed tomography. The main features of clinically determined leflunomide-induced acute lung injury were similar to those caused by other drugs: diffuse or widespread patchy ground-glass opacities and/or consolidation, frequently accompanied by septal thickening and intralobular reticular opacities. We categorized these findings into four patterns: diffuse alveolar damage (DAD), acute eosinophilic pneumonia, hyperreaction, and cryptogenic organizing pneumonia. The DAD group had a higher mortality rate, but statistically not a significant one. It is impossible to exclude infectious disease such as pneumocystis carinii pneumonia based on imaging findings, and detailed correlation of imaging findings with clinical and laboratory findings is essential in order to make a correct diagnosis.
authors.affiliation: Respiratory Subcommittee of Arava External Safety Review Board, Japan. fmksakai@yahoo.co.jp
authors.forename: Fumikazu
authors.initials: F
authors.lastname: Sakai
authors.forename: Satoshi
authors.initials: S
authors.lastname: Noma
authors.forename: Yasuyuki
authors.initials: Y
authors.lastname: Kurihara
authors.forename: Hidehiro
authors.initials: H
authors.lastname: Yamada
authors.forename: Arata
authors.initials: A
authors.lastname: Azuma
authors.forename: Shoji
authors.initials: S
authors.lastname: Kudoh
authors.forename: Youichi
authors.initials: Y
authors.lastname: Ichikawa