Keng Li-Ta, Lin Mong-Wei, Huang Hsien-Neng, Chung Kuei-Pin
aDepartments of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu bDepartments of Surgery, National Taiwan University Hospital, Taipei cDepartments of Pathology, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu dDepartment of Laboratory Medicine, National Taiwan University Hospital, Taipei, Taiwan.
Medicine (Baltimore). 2016 Jun;95(26):e4044. doi: 10.1097/MD.0000000000004044.
Patients with rheumatoid arthritis (RA) often have pulmonary involvement, and interstitial lung disease (ILD) is the primary manifestation, in which diffuse alveolar damage (DAD) is a rare histopathologic pattern. Leflunomide (LEF) is a frequently prescribed disease-modifying antirheumatic drug for treating RA. LEF-related ILD in the form of DAD has been reported in patients with RA, with the duration of LEF treatment before symptom onset ranging from 6 to 1204 days.We present a case of elderly woman with RA under prolonged LEF treatment for >9 years (3291 days), who had acute respiratory failure with the initial presentation of exertional dyspnea, fever, chills, and productive cough for 2 days. The histopathologic result of surgical lung biopsy was compatible with DAD. She was diagnosed as having LEF-related ILD, based on correlated clinical history, compatible histopathologic examination and excluding possible infection after extensive survey.Although the causative role of LEF cannot be confirmed, this case still hints that LEF-related DAD may occur even if LEF has been prescribed for a prolonged period.
类风湿关节炎（RA）患者常伴有肺部受累，其中间质性肺疾病（ILD）是主要表现形式，而弥漫性肺泡损伤（DAD）是一种罕见的组织病理学模式。来氟米特（LEF）是治疗RA常用的改善病情抗风湿药。已有RA患者出现以DAD形式存在的与LEF相关的ILD的报道，症状出现前LEF治疗时长为6至1204天。我们报告一例老年女性RA患者，接受LEF长期治疗超过9年（3291天），最初表现为劳力性呼吸困难、发热、寒战及咳痰2天，随后出现急性呼吸衰竭。手术肺活检的组织病理学结果符合DAD。基于相关临床病史、相符的组织病理学检查以及广泛排查后排除可能的感染，她被诊断为与LEF相关的ILD。尽管无法证实LEF的致病作用，但该病例仍提示，即使长期使用LEF，仍可能发生与LEF相关的DAD。
