[Referring to an unusual case: pulmonary affection and rheumatoid arthritis].
We report the case of a 60 year female patient suffering from rheumatoid arthritis for the last 25 years, under TNF-blocker and leflunomide, affected by a recurrent pneumothorax with several subpleural nodules, basal bronchiectasis and apical bullous emphysema. The patient was administered several treatments: aspiration, talc pleurodesis, surgical pleurodesis, pleurodesis induced by tetracycline and autologous blood. To allow the pleural inflammatory reaction necessary to the success of the pleurodesis, we had to interrupt the treatment by TNF-blocker and leflunomide. We then witnessed a partial pleurodesis with persistence of a pneumothorax. The medical situation is improving with disappearance of dyspnea.
Borges
Helder
H
Centre valaisan de pneumologie, Centre hospitalier du centre du Valais (CHCVs) Route de la Moubra 87, 3963 Montana-Crans. helder.borges@rsv-gnw.ch
Schnyder
Jean-Marie
JM
Frey
Jean-Georges
JG
Tschopp
Jean-Marie
JM
D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D018501:Antirheumatic Agents / Q000008:administration & dosage / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000150:complications* / Q000188:drug therapy / Q000503:physiopathology; D001987:Bronchiectasis / Q000209:etiology; D004417:Dyspnea / Q000209:etiology; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000627:therapeutic use; D007555:Isoxazoles / Q000008:administration & dosage / Q000627:therapeutic use; D000077339:Leflunomide; D008171:Lung Diseases / Q000188:drug therapy / Q000209:etiology* / Q000628:therapy; D008875:Middle Aged; D010995:Pleural Diseases / Q000209:etiology; D018700:Pleurodesis / Q000379:methods*; D011030:Pneumothorax / Q000097:blood / Q000000981:diagnostic imaging / Q000209:etiology* / Q000628:therapy; D011656:Pulmonary Emphysema / Q000209:etiology; D013902:Radiography, Thoracic; D012008:Recurrence; D013752:Tetracycline / Q000008:administration & dosage* / Q000627:therapeutic use; D013997:Time Factors; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors
D000900:Anti-Bacterial Agents; D018501:Antirheumatic Agents; D007166:Immunosuppressive Agents; D007555:Isoxazoles; D014409:Tumor Necrosis Factor-alpha; D013752:Tetracycline; D000077339:Leflunomide