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Je, Lee, Na, Seo, Seo, Kim, Choi, Lee, Ji, and Song: Leflunomide-induced Toxic Epidermal Necrolysis in a Patient with Rheumatoid Arthritis
Case Report

J Rheum Dis 2014;21(6):326-330.

Published online: 31 October 2014

DOI: https://doi.org/10.4078/jrd.2014.21.6.326

Leflunomide-induced Toxic Epidermal Necrolysis in a Patient with Rheumatoid Arthritis

Ji Hye Je, Hyun Jung Lee, Young Ju Na, Ji Hye Seo, Young Ho Seo, Jae-Hoon Kim, Sung Jae Choi, Young Ho Lee, Jong Dae Ji, Gwan Gyu Song

Division of Rheumatology, Department of Internal Medicine, College of Medicine, Korea University, Seoul, Korea

Corresponding to: Sung Jae Choi, Division of Rheumatology, Department of Internal Medicine, Korea University Ansan Hospital, 123, Jeokgeum-ro, Danwon-gu, Ansan 425-707, Korea. E-mail: csjmd@hotmail.com

Received 11 November 2013       Revised 3 March 2014       Accepted 7 March 2014

Copyright © 2014 The Korean College of Rheumatology

This is a Free Access article, which permits unrestricted non-commerical use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Leflunomide was licensed for the treatment of rheumatoid arthritis in 1998 and has been available in Korea since 2003. Allergic cutaneous reactions (rash, purpura) are common (＜10%) side effects of leflunomide, but severe cases such as Stevens-Johnson syndrome (SJS) or toxic epidermal necrolysis (TEN) are rarely reported. There has not been a report of SJS or TEN induced by leflunomide in Korea. Here we report a case of leflunomide-induced TEN in a patient with rheumatoid arthritis. Leflunomide was discontinued, and the TEN was treated with methylprednisolone, cholestyramine and immunoglobulin. The skin lesion eventually resolved over four weeks with residual post-inflammatory hyperpigmentation.

Keywords: Leflunomide, Toxic epidermal necrolysis, Rheumatoid arthritis

REFERENCES

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Figure 1.
Day 1, The patient had diffuse erythema of the face, erosion of the lips and oral mucosa, and erythematous macules and multiple clear, small, fluid-filled vesicles on her extremities.
jrd-21-326f1.tif
Figure 2.
H&E stain, ×200, subepidermal blister.
jrd-21-326f2.tif
Figure 3.
Day 6, The vesicles and macules changed to bullae, and Nikolsky's sign was present.
jrd-21-326f3.tif
Figure 4.
Day 8, Disrupted vesicles with crusting and spontaneous bleeding were evident during the re-epithelialization period.
jrd-21-326f4.tif
Figure 5.
Day 26, The skin lesions resolved with residual post-inflammatory hyperpigmentation.
jrd-21-326f5.tif
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