CASE REPORT
Leflunomide-related acute interstitial pneumonia in two patients with rheumatoid arthritis: autopsy findings with a mosaic pattern of acute and organizing diffuse alveolar damage
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Sae Ochi1, Masayoshi Harigai1,2,3, Fumitaka Mizoguchi1, Hideyuki Iwai1, Hiroyuki Hagiyama1, Teruaki Oka4 and Nobuyuki Miyasaka1
| (1) |
Department of Medicine and Rheumatology, Graduate School, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan |
| (2) |
Clinical Research Center, Tokyo Medical and Dental University Hospital, Tokyo, Japan |
| (3) |
First Department of Pathology, Yamagata University School of Medicine, Yamagata, Japan |
| (4) |
Department of Pathology, Kanto Central Hospital of the Mutual Aid Association of Public School Teachers, Tokyo, Japan |
Received: 11 May 2006 Accepted: 15 June 2006
Abstract We describe two cases of leflunomide-related interstitial pneumonia (IP). A 75-year-old woman with rheumatoid arthritis (RA) developed rapidly progressing IP 45 days after institution of leflunomide. She died of respiratory failure, and an autopsy revealed a mixed pattern of acute and organizing diffuse alveolar damage. A 69-year-old woman with RA also developed acute IP 3 months after institution of leflunomide. Methylprednisolone pulse therapy and cholestyramine ameliorated her IP. The implication of leflunomide in the pathogenesis of IP was suggested.
Key words Drug toxicity - Interstitial pneumonia (IP) - Leflunomide - Rheumatoid arthritis (RA)
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