Leflunomide induced acute interstitial pneumonia
Last revised by Yuranga Weerakkody on 28 Mar 2022
Citation, DOI, disclosures and article data
Citation:
Weerakkody Y, Hacking C, Knipe H, et al. Leflunomide induced acute interstitial pneumonia. Reference article, Radiopaedia.org (Accessed on 19 Apr 2024) https://doi.org/10.53347/rID-47794
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rID:
47794
Article created:
3 Sep 2016,
Yuranga Weerakkody ◉
Disclosures:
At the time the article was created Yuranga Weerakkody had no recorded disclosures.
View Yuranga Weerakkody's current disclosures
Last revised:
28 Mar 2022,
Yuranga Weerakkody ◉
Disclosures:
At the time the article was last revised Yuranga Weerakkody had no recorded disclosures.
View Yuranga Weerakkody's current disclosures
Revisions:
6 times, by
4 contributors -
see full revision history and disclosures
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Synonyms:
- Leflunomide induced acute interstitial pneumonitis
- Arava induced acute interstitial pneumonia
- Arava induced acute interstitial pneumonitis
Leflunomide induced acute interstitial pneumonia is a form of drug induced interstitial lung disease. The precipitation of radiological evidence of pulmonary infiltrates, clinical acute respiratory illness in the context of a good temporal relationship with commencement of the agent and no clear evidence of precipitating infection could suggest the diagnosis.
On this page:
Pathology
Leflunomide (or Arava TM) is a disease-modifying anti-rheumatic drug (DMARD) that is used in patients with rheumatoid arthritis (RA). Patients can get an acute deterioration of symptoms which can clinically progress like an acute interstitial pneumonitis.
Treatment and prognosis
The overall prognosis is variable with some cases even reported as being fatal 5. Agents such as prednisolone (pulse therapy) and cholestyramine have been used and prompt treatment with cessation of agent may improve overall prognosis.
Differential diagnosis
On imaging possible differential considerations include
- sudden rapid progression of preexisting interstitial fibrosis in rheumatoid disease
- concurrent complicating multifocal infective process such as pneumocystis pneumonia 4 or mycoplasma pneumonia etc.
References
- 1. Takeishi M, Akiyama Y, Akiba H et-al. Leflunomide induced acute interstitial pneumonia. J. Rheumatol. 2005;32 (6): 1160-3. Pubmed citation
- 2. Maskey-Warzęchowska M, Karwat K, Szczepankiewicz B et-al. Leflunomide-induced acute interstitial pneumonia in a patient treated for rheumatoid arthritis. Pneumonol Alergol Pol. 2015;83 (1): 50-4. doi:10.5603/PiAP.2015.0007 - Pubmed citation
- 3. Savage RL, Highton J, Boyd IW et-al. Pneumonitis associated with leflunomide: a profile of New Zealand and Australian reports. Intern Med J. 2006;36 (3): 162-9. doi:10.1111/j.1445-5994.2006.01035.x - Pubmed citation
- 4. Hirabayashi Y, Shimizu H, Kobayashi N et-al. Leflunomide-induced pneumonitis in a patient with rheumatoid arthritis. Intern. Med. 2006;45 (10): 689-91. Pubmed citation
- 5. Kamata Y, Nara H, Kamimura T et-al. Rheumatoid arthritis complicated with acute interstitial pneumonia induced by leflunomide as an adverse reaction. Intern. Med. 2005;43 (12): 1201-4. Pubmed citation
- 6. Raj R, Nugent K. Leflunomide-induced interstitial lung disease (a systematic review). (2013) Sarcoidosis, vasculitis, and diffuse lung diseases : official journal of WASOG. 30 (3): 167-76. Pubmed
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