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Shin, Kim, Kim, Ju, and Ko: A Case of Interstitial Pneumonitis in a Patient with Rheumatoid Arthritis Treated with Leflunomide
Case Report
Tuberculosis and Respiratory Diseases

Tuberculosis and Respiratory Diseases 2009; 66(6): 477-481.

Published online: 30 June 2009

DOI: https://doi.org/10.4046/trd.2009.66.6.477

A Case of Interstitial Pneumonitis in a Patient with Rheumatoid Arthritis Treated with Leflunomide

Ah-Young Shin, M.D.1, Seung Soo Kim, M.D.2, Kyung-Hee Kim, M.D.2, Il-Nam Ju, M.D.2, Hyeok Jae Ko, M.D.1

1Division of Rheumatology, Department of Internal Medicine, Daejeon St. Mary's Hospital, The Catholic University of Korea, Daejeon, Korea.

2Division of Pulmonology, Department of Internal Medicine, Daejeon St. Mary's Hospital, The Catholic University of Korea, Daejeon, Korea.

Address for correspondence: Hyeok Jae Ko, M.D. Division of Rheumatology, Department of Internal Medicine, Daejeon St. Mary's Hospital, The Catholic University of Korea, 520-2, Daehung-dong, Jung-gu, Daejeon 301-723, Korea. Phone: 82-42-220-9831, Fax: 82-42-255-8663, kohj8804@catholic.ac.kr

Received 25 May 2009       Accepted 17 June 2009

Copyright©2009. The Korean Academy of Tuberculosis and Respiratory Diseases. All rights reserved.

Abstract

Leflunomide, a disease-modifying antirheumatic drug (DMARD) for the treatment of rheumatoid arthritis has been available in Korea since 2003. Leflunomide-associated interstitial pneumonitis has been appearing recently. A 25-year-old woman with a 12-month history of seronegative rheumatoid arthritis (RA) presented with acute respiratory insufficiency. She developed fever, dyspnea, and non-productive cough. Her medication history included methotrexate (15 mg/week. commencing 1 year prior) and leflunomide (20 mg/day, no loading dose, commencing 4 months prior). She was diagnosed with leflunomide-associated interstitial pneumonitis based on history, physical examination, laboratory and radiologic findings. She recovered quickly after leflunomide was withdrawn and steroids and cholestyramine were initiated quickly. We report a case of leflunomide-associated interstitial pneumonitis treated successfully with intravenous high-dose steroid and cholestyramine.

Keywords: Leflunomide, Interstitial lung diseases, Rheumatoid arthritis

Figures and Tables

Figure 1
(A) Chest X-ray shows diffuse infiltration and haziness on both lung fields. (B) At 3 days after treatment start, follow up chest X-ray shows resolution of previous infiltration and haziness.
trd-66-477-g001
Figure 2
Chest computed tomography imaging shows ground-glass opacity and consolidation in her both whole lung fields.
trd-66-477-g002

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