Leflunomide-induced toxic epidermal necrolysis in a patient with rheumatoid arthritis.
BACKGROUND
Leflunomide is an immunomodulating agent with proven efficacy in rheumatoid arthritis. Although its overall safety profile is good, a few cases of toxic epidermal necrolysis have been reported.


METHODS
This 36-year-old woman had rheumatoid arthritis that proved refractory to sulfasalazine and methotrexate, which were used successively in combination with symptomatic drugs. Leflunomide was started. A maculopapular rash and a fever developed 2 weeks later. The skin lesions spread rapidly to most of the body, and ulcers of the ocular and oral mucosa appeared. Leflunomide was stopped. Cholestyramine washout and prednisolone (60 mg/day) were given. The skin lesions healed over the next month. Punctate keratitis with keratinization of the cornea led to complete loss of vision.


CONCLUSIONS
The main adverse effects of leflunomide consist of diarrhea, nausea, liver enzyme elevation, hypertension, alopecia, and allergic skin reactions. A few cases of severe skin reactions such as toxic epidermal necrolysis have been reported. They require immediate discontinuation of the drug and a washout procedure to hasten drug elimination from the body.


CONCLUSIONS
Close monitoring for severe skin reactions is in order when using leflunomide.
Hassikou
Hasna
H
Service de Médecine Interne, Hôpital Militaire Moulay Ismail, Meknes, Morocco. hassikouhasna@hotmail.com
El Haouri
Mohamed
M
Tabache
Fatima
F
Baaj
Mohamed
M
Safi
Somaya
S
Hadri
Larbi
L
D000276:Adjuvants, Immunologic / Q000009:adverse effects*; D000328:Adult; D001172:Arthritis, Rheumatoid / Q000150:complications / Q000188:drug therapy*; D002792:Cholestyramine Resin / Q000627:therapeutic use; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D007475:Ion Exchange Resins / Q000627:therapeutic use; D007555:Isoxazoles / Q000009:adverse effects*; D000077339:Leflunomide; D011239:Prednisolone / Q000627:therapeutic use; D013262:Stevens-Johnson Syndrome / Q000188:drug therapy / Q000209:etiology* / Q000473:pathology
D000276:Adjuvants, Immunologic; D005938:Glucocorticoids; D007475:Ion Exchange Resins; D007555:Isoxazoles; D002792:Cholestyramine Resin; D011239:Prednisolone; D000077339:Leflunomide