title: Pancytopenia, including macrocytic anemia, associated with leflunomide in a rheumatoid arthritis patient.
abstract: A female rheumatoid arthritis patient was admitted for productive cough and general fatigue that had gradually developed after leflunomide therapy. Side effects including severe hypoxia, thrombocytopenia, lymphocytopenia, and macrocytic anemia with schistocytes (probably drug-induced megaloblastic anemia) were noted. Leflunomide-eliminating cholestyramine therapy successfully treated all conditions excluding severe hypoxia, which occurred owing to deteriorating interstitial pneumonia and complicated bacterial pneumonia following antibiotic treatment. This is a rare case of leflunomide-associated multiple hematopoietic impairments.
authors.affiliation: Division of Rheumatology, Department of Internal Medicine, Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo, 105-8461, Japan. yasuhiko@f-h.nir.jp
authors.forename: Yasuhiko
authors.initials: Y
authors.lastname: Toyokawa
authors.forename: Isamu
authors.initials: I
authors.lastname: Kingetsu
authors.forename: Chiho
authors.initials: C
authors.lastname: Yasuda
authors.forename: Jun
authors.initials: J
authors.lastname: Yasuda
authors.forename: Ken
authors.initials: K
authors.lastname: Yoshida
authors.forename: Daitaro
authors.initials: D
authors.lastname: Kurosaka
authors.forename: Akio
authors.initials: A
authors.lastname: Yamada
mesh_terms: D000368:Aged; D000748:Anemia, Macrocytic / Q000139:chemically induced* / Q000150:complications; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects*; D018501:Antirheumatic Agents / Q000009:adverse effects*; D001172:Arthritis, Rheumatoid / Q000150:complications / Q000188:drug therapy*; D005260:Female; D006801:Humans; D007555:Isoxazoles / Q000009:adverse effects*; D000077339:Leflunomide; D010198:Pancytopenia / Q000139:chemically induced* / Q000150:complications; D013902:Radiography, Thoracic; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D018501:Antirheumatic Agents; D007555:Isoxazoles; D000077339:Leflunomide