CASE REPORT

Pancytopenia, including macrocytic anemia, associated with leflunomide in a rheumatoid arthritis patient

Authors

Yasuhiko Toyokawa^1,2, Isamu Kingetsu¹, Chiho Yasuda¹, Jun Yasuda¹, Ken Yoshida¹, Daitaro Kurosaka¹ and Akio Yamada¹

1. Division of Rheumatology, Department of Internal Medicine, Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo 105-8461, Japan
2. Present address: Toyokawa Clinic, 3-22-12 Kotesashi-cho, Tokorozawa 359-1141, Japan

Received:

07 November 2006

Accepted:

01 June 2007

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Abstract

A female rheumatoid arthritis patient was admitted for productive cough and general fatigue that had gradually developed after leflunomide therapy. Side effects including severe hypoxia, thrombocytopenia, lymphocytopenia, and macrocytic anemia with schistocytes (probably drug-induced megaloblastic anemia) were noted. Leflunomide-eliminating cholestyramine therapy successfully treated all conditions excluding severe hypoxia, which occurred owing to deteriorating interstitial pneumonia and complicated bacterial pneumonia following antibiotic treatment. This is a rare case of leflunomide-associated multiple hematopoietic impairments.

Key words

Drug-induced megaloblastic anemia - Leflunomide - Macrocytic anemia - Pancytopenia