title: Intrapulmonary rheumatoid nodules in a patient with long-standing rheumatoid arthritis treated with leflunomide.
abstract: Rheumatoid nodules are well established manifestations of rheumatoid arthritis but in the lungs they are very rare according to the literature. In our study we present the case of a 34-year-old woman with rheumatoid arthritis and secondary Sjögren's syndrome who developed multiplex rheumatoid nodules in the lungs 3 years after initiating leflunomide therapy. During leflunomide therapy we did not detect inflammation in the joints. Surprisingly, in November 2005 she started to cough, had low grade fever and low back pain. On the chest X-ray there were multiplex necrobiotic nodules in the lungs. All bacteriological, viral and fungal investigations including tuberculosis, serological tests and cytology were negative. The X-ray, video-associated thoracoscopy and repeated biopsy of the lung followed by histology of the samples proved intrapulmonary rheumatoid nodules, caused by leflunomide.
authors.forename: Ildiko Fanny
authors.initials: IF
authors.lastname: Horvath
authors.forename: Antonia
authors.initials: A
authors.lastname: Szanto
authors.forename: Zoltan
authors.initials: Z
authors.lastname: Csiki
authors.forename: Peter
authors.initials: P
authors.lastname: Szodoray
authors.forename: Margit
authors.initials: M
authors.lastname: Zeher
mesh_terms: D000328:Adult; D001172:Arthritis, Rheumatoid / Q000175:diagnosis / Q000188:drug therapy* / Q000473:pathology; D002908:Chronic Disease / Q000188:drug therapy; D005260:Female; D006801:Humans; D007555:Isoxazoles / Q000627:therapeutic use*; D000077339:Leflunomide; D008171:Lung Diseases / Q000175:diagnosis / Q000473:pathology; D055613:Multiple Pulmonary Nodules / Q000175:diagnosis / Q000473:pathology*; D012218:Rheumatoid Nodule / Q000150:complications / Q000175:diagnosis / Q000473:pathology*; D012859:Sjogren's Syndrome / Q000175:diagnosis; D013906:Thoracoscopy
chemical_list: D007555:Isoxazoles; D000077339:Leflunomide