Pulmonary abscess due to leflunomide use in rheumatoid arthritis: a case report

Ulusoy H., Bilgici A., Kuru O., Celenk C.

RHEUMATOLOGY INTERNATIONAL, vol.25, no.2, pp.139-142, 2005 (SCI-Expanded) identifier identifier

  • Publication Type: Article / Article
  • Volume: 25 Issue: 2
  • Publication Date: 2005
  • Doi Number: 10.1007/s00296-004-0493-6
  • Journal Name: RHEUMATOLOGY INTERNATIONAL
  • Journal Indexes: Science Citation Index Expanded (SCI-EXPANDED), Scopus
  • Page Numbers: pp.139-142
  • Keywords: infection, leflunomide, pulmonary abscess, rheumatoid arthritis, DE-NOVO SYNTHESIS, T-LYMPHOCYTES, DOUBLE-BLIND, PLACEBO, SAFETY, EFFICACY, METHOTREXATE, MECHANISM
  • Ondokuz Mayıs University Affiliated: Yes

Abstract

A 43-year-old woman had rheumatoid arthritis (RA) for 5 years and complained of fever, arthralgia/ myalgia, and night sweating for a month. She had been receiving only leflunomide (20 mg/day) for 5 months. On admission, there was no evidence of active arthritis or vasculitic lesion. Laboratory evaluation showed an erythrocyte sedimentation rate of 145 mm/h and C-reactive protein of 160 mg/dl. All cultures were negative. Chest radiograph and computed tomography (CT) revealed a pulmonary abscess. Staphylococcus aureus multiplied in the culture of a purulent sample obtained from the abscess under ultrasonography. The leflunomide was stopped, and sultamicillin (IV 4x2 g/day) was started for a further 6 weeks. Four weeks later, the patient had completely recovered and CT showed significant improvement of the pulmonary abscess. Ten milligrams/day of prednisolone and 7.5 mg/week of methotrexate were started for RA treatment. The patient has been under control for 5 months without any further abscess or RA activation.