Tuberculosis and Respiratory Diseases

  • 제66권6호
  • /
  • Pages.477-481
  • /
  • 2009
  • /
  • 1738-3536(pISSN)
  • /
  • 2005-6184(eISSN)
대한결핵및호흡기학회 (The Korean Academy of Tuberculosis and Respiratory Diseases)
권호 표지
DOI QR코드

DOI QR Code

Leflunomide로 치료중인 류마티스 관절염 환자에서 발생한 간질성 폐렴 1예

A Case of Interstitial Pneumonitis in a Patient with Rheumatoid Arthritis Treated with Leflunomide

  • 신아영 (가톨릭대학교 대전성모병원 류마티스내과학교실) ;
  • 김승수 (가톨릭대학교 대전성모병원 호흡기내과학교실) ;
  • 김경희 (가톨릭대학교 대전성모병원 호흡기내과학교실) ;
  • 주일남 (가톨릭대학교 대전성모병원 호흡기내과학교실) ;
  • 고혁재 (가톨릭대학교 대전성모병원 류마티스내과학교실)
  • Shin, Ah-Young (Divisions of Rheumatology, Department of Internal Medicine, Daejeon St. Mary's Hospital, The Catholic University of Korea) ;
  • Kim, Seung Soo (Divisions of Pulmonology, Department of Internal Medicine, Daejeon St. Mary's Hospital, The Catholic University of Korea) ;
  • Kim, Kyung Hee (Divisions of Pulmonology, Department of Internal Medicine, Daejeon St. Mary's Hospital, The Catholic University of Korea) ;
  • Ju, Il-Nam (Divisions of Pulmonology, Department of Internal Medicine, Daejeon St. Mary's Hospital, The Catholic University of Korea) ;
  • Ko, Hyeok Jae (Divisions of Rheumatology, Department of Internal Medicine, Daejeon St. Mary's Hospital, The Catholic University of Korea)
  • 투고 : 2009.05.25
  • 심사 : 2009.06.17
  • 발행 : 2009.06.30
PDF 다운로드
⟨ 이전 논문 다음 논문 ⟩

초록

Leflunomide는 항류마티스 약제로 최근 류마티스 관절염 치료에 효과적으로 사용되고 있다. 최근 본 약제로 인한 간질성 폐렴이 일본과 한국에서 서구에서보다 많이 보고되고 있으며 종종 사망하는 경우도 보고되고 있다. 저자들은 25세 여자에서 Methotrexate와 Leflunomide의 병합요법 중 발생한 간질성 폐렴을 진단하였고 Methylprednisolone과 Cholestyramine을 조기 투여하여 효과적으로 치료하였기에 문헌 고찰과 함께 보고하는 바이다.

Leflunomide, a disease-modifying antirheumatic drug (DMARD) for the treatment of rheumatoid arthritis has been available in Korea since 2003. Leflunomide-associated interstitial pneumonitis has been appearing recently. A 25-year-old woman with a 12-month history of seronegative rheumatoid arthritis (RA) presented with acute respiratory insufficiency. She developed fever, dyspnea, and non-productive cough. Her medication history included methotrexate (15 mg/week. commencing 1 year prior) and leflunomide (20 mg/day, no loading dose, commencing 4 months prior). She was diagnosed with leflunomide-associated interstitial pneumonitis based on history, physical examination, laboratory and radiologic findings. She recovered quickly after leflunomide was withdrawn and steroids and cholestyramine were initiated quickly. We report a case of leflunomide-associated interstitial pneumonitis treated successfully with intravenous high-dose steroid and cholestyramine.

키워드

참고문헌

  1. Park YB, Lee SK. Leflunomide: a new disease modifying anti-rheumatic drug. J Korean Rheum Assoc 2000;7: 323-32
  2. Kalden JR, Schattenkirchner M, Sörensen H, Emery P, Deighton C, Rozman B, et al. The efficacy and safety of leflunomide in patients with active rheumatoid arthritis: a five-year followup study. Arthritis Rheum 2003; 48:1513-20 https://doi.org/10.1002/art.11015
  3. Chikura B, Lane S, Dawson JK. Clinical expression of leflunomide-induced pneumonitis. Rheumatology (Oxford). Forthcoming 2009
  4. Savage RL, Highton J, Boyd IW, Chapman P. Pneumonitis associated with leflunomide: a profile of New Zealand and Australian reports. Intern Med J 2006; 36:162-9 https://doi.org/10.1111/j.1445-5994.2006.01035.x
  5. Lee JH, Cheon WS, Seo YI, Eom KS, Jang SH, Bahn JW, et al. A case of interstitial pneumonitis caused by leflunomide. Tuberc Respir Dis 2005;58:83-8 https://doi.org/10.4046/trd.2005.58.1.83
  6. Sheen DH, Lim MK, Shim SC, Lee SO, Kang SW, Song JK, et al. Successful treatment of interstitial pneumonitis induced by leflunomide. J Korean Rheum Assoc 2007; 14:268-73 https://doi.org/10.4078/jkra.2007.14.3.268
  7. Breedveld FC, Dayer JM. Leflunomide: mode of action in the treatment of rheumatoid arthritis. Ann Rheum Dis 2000;59:841-9 https://doi.org/10.1136/ard.59.11.841
  8. Bartlett RR, Brendel S, Zielinski T, Schorlemmer HU. Leflunomide, an immunorestoring drug for the therapy of autoimmune disorders, especially rheumatoid arthritis. Transplant Proc 1996;28:3074-8
  9. McCurry J. Japan deaths spark concerns over arthritis drug. Lancet 2004;363:461
  10. Searles G, McKendry RJ. Methotrexate pneumonitis in rheumatoid arthritis: potential risk factors. Four case reports and a review of the literature. J Rheumatol 1987; 14:1164-71
  11. Suissa S, Hudson M, Ernst P. Leflunomide use and the risk of interstitial lung disease in rheumatoid arthritis. Arthritis Rheum 2006;54:1435-9 https://doi.org/10.1002/art.21806
  12. Kremer J, Genovese M, Cannon GW, Caldwell J, Cush J, Furst DE, et al. Combination leflunomide and methotrexate (MTX) therapy for patients with active rheumatoid arthritis failing MTX monotherapy: open-label extension of a randomized, double-blind, placebo controlled trial. J Rheumatol 2004;31:1521-31
  13. Vallbracht II, Popper HH, Rieber J, Nowak F, Gallenberger S, Piper B, et al. Lethal pneumonitis under leflunomide therapy. Rheumatology (Oxford) 2005;44: 1580-1 https://doi.org/10.1093/rheumatology/kei076
  14. Chikura B, Sathi N, Lane S, Dawson JK. Variation of immunological response in methotrexate-induced pneumonitis. Rheumatology (Oxford) 2008;47:1647-50 https://doi.org/10.1093/rheumatology/ken356