title: Leflunomide-related acute interstitial pneumonia in two patients with rheumatoid arthritis: autopsy findings with a mosaic pattern of acute and organizing diffuse alveolar damage.
abstract: 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.
authors.affiliation: Department of Medicine and Rheumatology, Graduate School, Tokyo Medical and Dental University Hospital, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan.
authors.forename: Sae
authors.initials: S
authors.lastname: Ochi
authors.forename: Masayoshi
authors.initials: M
authors.lastname: Harigai
authors.forename: Fumitaka
authors.initials: F
authors.lastname: Mizoguchi
authors.forename: Hideyuki
authors.initials: H
authors.lastname: Iwai
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Hagiyama
authors.forename: Teruaki
authors.initials: T
authors.lastname: Oka
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Miyasaka
mesh_terms: 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
chemical_list: D000893:Anti-Inflammatory Agents; D018501:Antirheumatic Agents; D007555:Isoxazoles; D002792:Cholestyramine Resin; D000077339:Leflunomide; D008775:Methylprednisolone