Leflunomide-related acute interstitial pneumonia in two patients with rheumatoid arthritis: autopsy findings with a mosaic pattern of acute and organizing diffuse alveolar damage.
We describe two cases of leflunomide-related interstitial pneumonia (IP). A 75-year-old woman with rheumatoid arthritis (RA) developed rapidly progressing IP 45 days after institution of leflunomide. She died of respiratory failure, and an autopsy revealed a mixed pattern of acute and organizing diffuse alveolar damage. A 69-year-old woman with RA also developed acute IP 3 months after institution of leflunomide. Methylprednisolone pulse therapy and cholestyramine ameliorated her IP. The implication of leflunomide in the pathogenesis of IP was suggested.
Ochi
Sae
S
Department of Medicine and Rheumatology, Graduate School, Tokyo Medical and Dental University Hospital, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan.
Harigai
Masayoshi
M
Mizoguchi
Fumitaka
F
Iwai
Hideyuki
H
Hagiyama
Hiroyuki
H
Oka
Teruaki
T
Miyasaka
Nobuyuki
N
D000368:Aged; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D018501:Antirheumatic Agents / Q000009:adverse effects*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D001344:Autopsy; D002792:Cholestyramine Resin / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007555:Isoxazoles / Q000009:adverse effects*; D000077339:Leflunomide; D017563:Lung Diseases, Interstitial / Q000139:chemically induced* / Q000473:pathology* / Q000503:physiopathology; D008775:Methylprednisolone / Q000627:therapeutic use; D011650:Pulmonary Alveoli / Q000000981:diagnostic imaging / Q000473:pathology; D014057:Tomography, X-Ray Computed
D000893:Anti-Inflammatory Agents; D018501:Antirheumatic Agents; D007555:Isoxazoles; D002792:Cholestyramine Resin; D000077339:Leflunomide; D008775:Methylprednisolone