Huret B, Boulanger S, Benhamed L, Deprez X, Caparros D
Service de pneumologie, clinique Teissier, 119, avenue Desandrouins, 59300 Valenciennes, France.
Service de pneumologie, hôpital Victor-Provo, 17, boulevard Lacordaire, 59100 Roubaix, France.
Rev Mal Respir. 2017 Nov;34(9):1011-1015. doi: 10.1016/j.rmr.2016.11.005. Epub 2017 Oct 13.
Rheumatoid arthritis (RA) is a chronic inflammatory disease affecting the joints but which frequently includes extra articular effects, including pulmonary nodules, which grow faster under immunosuppressive treatment.
A 74 years old man, with mild asbestosis, underwent treatment with methotrexate then leflunomide (LEF) for seropositive RA. In February 2014, during monitoring of his asbestosis, chest CT scan showed the appearance of thick-walled cavitating lung nodules, with a central and sub pleural distribution. The patient was asymptomatic. Bronchoalveolar lavage excluded infection and tumor. LEF was stopped but in May 2014, the patient was admitted with respiratory infection and a pyopneumothorax which required surgical management. The postoperative course was complicated with a persistent pneumothorax.
We describe a case of RA complicated by a pyopneumothorax after treatment with LEF. The risk of this complication could be reduced by regular chest imaging.
类风湿性关节炎（RA）是一种影响关节的慢性炎症性疾病，但常常伴有关节外表现，包括肺结节，在免疫抑制治疗下肺结节生长更快。
一名74岁男性，患有轻度石棉肺，因血清阳性RA接受了甲氨蝶呤治疗，随后使用来氟米特（LEF）治疗。2014年2月，在对其石棉肺进行监测期间，胸部CT扫描显示出现厚壁空洞性肺结节，呈中央和胸膜下分布。患者无症状。支气管肺泡灌洗排除了感染和肿瘤。停用了LEF，但在2014年5月，患者因呼吸道感染和气胸入院，需要手术治疗。术后病程并发持续性气胸。
我们描述了一例在用LEF治疗后并发气胸的RA病例。通过定期胸部影像学检查可降低这种并发症的风险。
