Diffuse alveolar hemorrhage after leflunomide therapy in a patient with rheumatoid arthritis.
We report the case of a young man, affected by rheumatoid arthritis who developed a rapid-onset short-of-breath, hemoptysis, and severe weakness, about 2 weeks after the administration of leflunomide. Chest radiography showed central bilateral opacities and pleural effusion as confirmed by the high-resolution computed tomography that demonstrated diffuse ground-glass and interlobular septal thickening as well. On admission at the Emergency Department, a microhematuria and a severe anemia were also documented. On the basis of the clinico-radiologic presentation, a pulmonary hemorrhage was likely to occur; so to clarify the origin of this process, a complete serologic examination was performed but all the antibodies were negative. Finally a renal biopsy was performed and it showed a pauci-immunologic glomerulonephritis and the bronchioloalveolar lavage confirmed the diffuse alveolar hemorrhage. In conclusion, the diagnosis of leflunomide-pulmonary-renal syndrome was rendered. The treatment with leflunomide was suspended; the conditions of the patient gradually improved and he became completely asymptomatic 1 week later.
Carloni
Angelo
A
Department of Radiology, Ospedale Civile S. Maria, Italy.
Piciucchi
Sara
S
Giannakakis
Kostantinos
K
Nori
Gianrenato
G
Zobel
Bruno Beomonte
BB
Poletti
Venerino
V
D000328:Adult; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D001706:Biopsy; D003937:Diagnosis, Differential; D004417:Dyspnea / Q000139:chemically induced; D006469:Hemoptysis / Q000139:chemically induced; D006470:Hemorrhage / Q000139:chemically induced* / Q000175:diagnosis / Q000628:therapy; D006801:Humans; D007555:Isoxazoles / Q000009:adverse effects*; D007668:Kidney / Q000187:drug effects / Q000473:pathology; D000077339:Leflunomide; D008168:Lung / Q000000981:diagnostic imaging; D008171:Lung Diseases / Q000139:chemically induced* / Q000175:diagnosis / Q000188:drug therapy; D008297:Male; D008775:Methylprednisolone / Q000627:therapeutic use; D018908:Muscle Weakness / Q000139:chemically induced; D010996:Pleural Effusion / Q000139:chemically induced; D011650:Pulmonary Alveoli / Q000187:drug effects*; D014057:Tomography, X-Ray Computed
D000894:Anti-Inflammatory Agents, Non-Steroidal; D007555:Isoxazoles; D000077339:Leflunomide; D008775:Methylprednisolone