Pancytopenia, including macrocytic anemia, associated with leflunomide in a rheumatoid arthritis patient.
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.
Toyokawa
Yasuhiko
Y
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
Kingetsu
Isamu
I
Yasuda
Chiho
C
Yasuda
Jun
J
Yoshida
Ken
K
Kurosaka
Daitaro
D
Yamada
Akio
A
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
D000894:Anti-Inflammatory Agents, Non-Steroidal; D018501:Antirheumatic Agents; D007555:Isoxazoles; D000077339:Leflunomide