Case Reports
7 May 2025
Vol. 19 No. 2 (2025)
Pulmonary nodules in rheumatoid arthritis: the case of leflunomide
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
374
Views
129
Downloads
15
HTML
Authors
Rheumatoid arthritis (RA) is a chronic autoimmune disease primarily affecting joints. Extra-articular manifestations, including pulmonary involvement, significantly contribute to morbidity and mortality. Disease-modifying antirheumatic drugs are crucial for RA treatment but may also have pulmonary side effects. The differentiation between pulmonary RA manifestations, infection in the immunosuppressed patient, and drug-induced pulmonary toxicity remains a diagnostic and therapeutic challenge. This report presents a rare case of accelerated pulmonary nodulosis associated with leflunomide therapy, emphasizing the need for careful differential diagnosis in immunosuppressed patients.
Altmetrics
Downloads
Download data is not yet available.
Citations
Cross M, Smith E, Hoy D, et al. The global burden of rheumatoid arthritis: estimates from the Global Burden of Disease 2010 study. Ann Rheum Dis 2014;73:1316-22. DOI: https://doi.org/10.1136/annrheumdis-2013-204627
Tashfeen M, Jose C, Isham I, Kenneth N. The effect of disease modifying drugs on the lung in patients with rheumatoid arthritis. Southwest Respir Crit Care Chron 2016;4:3-11. DOI: https://doi.org/10.12746/swrccc2016.0413.166
Spagnolo P, Lee JS, Sverzellati N, et al. The lung in rheumatoid arthritis: focus on interstitial lung disease. Arthritis Rheumatol. 2018;70(10):1544-54. DOI: https://doi.org/10.1002/art.40574
ARAVA® (leflunomide) prescribing information. Bridgewater, NJ: Sanofi-Aventis; 2010. Food and Drug Administration. Available from: https://www.accessdata.fda.gov/drugsatfda_docs/label/2010/020905s020lbl.pdf.
Wong SPY, Chu CM, Kan CH, et al. Successful treatment of leflunomide-induced acute pneumonitis with cholestyramine wash-out therapy. J Clin Rheumatol 2009;15:389-92. DOI: https://doi.org/10.1097/RHU.0b013e3181c3f87e
Skeoch S, Weatherley N, Swift AJ, et al. Drug-induced interstitial lung disease: a systematic review. J Clin Med 2018;7:356. DOI: https://doi.org/10.3390/jcm7100356
Lacoste-Palasset T, Chaumais MC, Weatherald J, et al. Association between Leflunomide and Pulmonary Hypertension. Ann Am Thorac Soc 2021;18:1306-15. DOI: https://doi.org/10.1183/13993003.congress-2021.OA146
Martin N, Innes JA, Lambert CM, et al. Hypersensitivity pneumonitis associated with leflunomide therapy. J Rheumatol 2007;34:1934-7.
Raj R, Nugent K. Leflunomide-induced interstitial lung disease: a systematic review. Sarcoidosis Vasc Diffuse Lung Dis 2013;30:167-76.
Sakai F, Noma S, Kurihara Y, et al. Leflunomide-related lung injury in patients with rheumatoid arthritis: imaging features. Mod Rheumatol 2005;15:173-9. DOI: https://doi.org/10.1007/s10165-005-0387-9
Rozin A, Yigla M, Guralnik L, et al. Rheumatoid lung nodulosis and osteopathy associated with leflunomide therapy. Clin Rheumatol 2006;25:384-8. DOI: https://doi.org/10.1007/s10067-005-0024-1
Abiyarghamsari M, Ahmadzadeh A. Pulmonary nodules after leflunomide therapy in rheumatoid arthritis: a case report. Clin Case Rep 2024;13:e9615. DOI: https://doi.org/10.1002/ccr3.9615
Karadag F, Polatli M, Senturk T, et al. Cavitary necrobiotic nodule imitating malignant lung disease in a patient without articular manifestations of rheumatoid arthritis. J Clin Rheumatol 2003;9:246-52. DOI: https://doi.org/10.1097/01.rhu.0000081260.50171.bf
McCurry J. Japan deaths spark concerns over arthritis drug. Lancet 2004;363:461. DOI: https://doi.org/10.1016/S0140-6736(04)15527-X
Suissa S, Hudson M, Ernst P. Leflunomide use and the risk of interstitial lung disease in rheumatoid arthritis. Arthritis Rheum 2006;54:1435-9. DOI: https://doi.org/10.1002/art.21806
Braun MG, van Rhee R, Becker-Capeller D. Neuauftreten und/oder Zunahme von Rheumaknoten unter Leflunomidtherapie bei RA-Patienten. Z Rheumatol 2004;63:84-7. DOI: https://doi.org/10.1007/s00393-004-0537-z
Grisar J. Leflunomide inhibits transendothelial migration of peripheral blood mononuclear cells. Ann Rheum Dis 2004;63:1632-7. DOI: https://doi.org/10.1136/ard.2003.018440
How to Cite
Pulmonary nodules in rheumatoid arthritis: the case of leflunomide. (2025). Italian Journal of Medicine, 19(2). https://doi.org/10.4081/itjm.2025.1964
Copyright (c) 2025 the Author(s)
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
PAGEPress has chosen to apply the Creative Commons Attribution NonCommercial 4.0 International License (CC BY-NC 4.0) to all manuscripts to be published.
Similar Articles
- Mario Visconti, Autoimmune liver diseases: internist's guide from bench to bedside , Italian Journal of Medicine: Vol. 9 No. 1 (2015)
- David Micarelli, Gianluca Santoboni, Michela Tarnani, Claudio Angrisani, Alessandra Fiorentini, Carlo Meschini, A case of hemolytic anemia associated with interstitial lung disease, arthralgia and fever caused by Mycoplasma pneumoniae , Italian Journal of Medicine: Vol. 15 No. 2 (2021)
- Carmine Siniscalchi, Pietro Rossetti, Gaetano Carolla, Pierpaolo Di Micco, Adriano Stella, Michele Riva, A review on management of antiphospholipid syndrome in clinical practice , Italian Journal of Medicine: Vol. 17 No. 2 (2023)
- Lucio Brugioni, Chiara Catena, Eugenio Ferraro, Serena Scarabottini, Francesca Mori, Enrico Clini, A case of dyspnea: respiratory failure due to pulmonary arteriovenous malformation , Italian Journal of Medicine: Vol. 13 No. 4 (2019)
- Daniela Tirotta, Vittorio Durante, Problem-solving combined with ultrasonography: a strategy for internists to improve case management and reduce diagnostic errors , Italian Journal of Medicine: Vol. 8 No. 1 (2014)
- Pasquale Palmiero, Maria Maiello, Francesca Amati, Marco Matteo Ciccone, Timir Paul, Association between metabolic syndrome, hypertension, and chronic depression: a postmenopausal women prevention study , Italian Journal of Medicine: Vol. 17 No. 1 (2023)
- Carlo Di Donato, Monica Vecchi, Vincenzo Ferrari, Giampaolo Papi, Cristina Gozzi, Agranulocytosis in a patient with acute Parvovirus B19 infection: a case study , Italian Journal of Medicine: Vol. 10 No. 1 (2016)
- P24 | A case of nocardiosis mimicking metastatic pulmonary neoplasm , Italian Journal of Medicine: Vol. 19 No. 1(s1) (2025): XXX FADOI Italian Congress | 10-12 May 2025
- Marco Delle Monache, Marco Carli, Annarita Vestri, Lorenzo Nosotti, Teresa Morgillo, Michele Delle Monache, Collecting clinical data during an emergency: quality of life in primary biliary cholangitis during the COVID-19 pandemic , Italian Journal of Medicine: Vol. 17 No. 2 (2023)
- Sandro José Martins, José Carlos de Almeida, Vitorino Modesto dos Santos, Ana Carolina Vieira Cançado, Giovanna Ferraz Cavalcanti, Kelle Regina Alves Ribeiro, An 81-year-old patient with recent diagnosis of classic testicular seminoma , Italian Journal of Medicine: Vol. 10 No. 2 (2016)
You may also start an advanced similarity search for this article.