Leflunomide, a disease-modifying antirheumatic drug, is effective for rheumatoid arthritis as monotherapy or combination therapy with methotrexate. The most common adverse effects are diarrhea, dyspepsia, nausea, abdominal pain, oral ulcer, hepatotoxicity, skin rash, hypertension, weight loss, and interstitial lung disease. The occurrence of pulmonary cryptococcosis in leflunomide treatment has not been reported in Korea. A 74-year-old woman was admitted to hospital due to asymptomatic pulmonary nodule. She was diagnosed rheumatoid arthritis and treated with leflunomide 5 months ago due to treatment failure with methotrexate, hydroxychloroquine, and sulfasalazine. Chest radiograph and computed tomography showed solitary pulmonary nodule in her right lower lung. Pulmonary cryptococcosis was confirmed by needle biopsy of lung stained with Gomori methenamine silver and mucicarmine. The lesion was improved after antifungal therapy for 3 months.
Abdominal Pain ; Aged ; Arthritis, Rheumatoid* ; Biopsy, Needle ; Cryptococcosis* ; Diarrhea ; Dyspepsia ; Exanthema ; Female ; Humans ; Hydroxychloroquine ; Hypertension ; Korea ; Lung ; Lung Diseases, Interstitial ; Methenamine ; Methotrexate ; Nausea ; Oral Ulcer ; Radiography, Thoracic ; Solitary Pulmonary Nodule ; Sulfasalazine ; Treatment Failure ; Weight Loss

Adult onset Still's disease (AOSD) is a systemic inflammatory disorder of unknown etiology. AOSD is characterized by fever, arthralgia, salmon-colored skin rash, hepatosplenomegaly and its laboratory abnormalities include leukocytosis, elevated liver enzyme, negative autoantibody, and hyperferritinemia. The clinical course varied and severe complicated conditions, such as hemophagocytic syndrome, and disseminated intravascular coagulation, occurred occasionally. Such a complication is accompanied with hemolytic anemia and lead to be a fatal course. We report the first case of AOSD with hemolytic anemia, which improved with high dose steroid therapy.
Adult ; Anemia, Hemolytic ; Arthralgia ; Disseminated Intravascular Coagulation ; Exanthema ; Fever ; Humans ; Leukocytosis ; Liver ; Lymphohistiocytosis, Hemophagocytic ; Still's Disease, Adult-Onset

Adult onset Still's disease (AOSD) is a systemic inflammatory disorder of unknown etiology. AOSD is characterized by fever, arthralgia, salmon-colored skin rash, hepatosplenomegaly and its laboratory abnormalities include leukocytosis, elevated liver enzyme, negative autoantibody, and hyperferritinemia. The clinical course varied and severe complicated conditions, such as hemophagocytic syndrome, and disseminated intravascular coagulation, occurred occasionally. Such a complication is accompanied with hemolytic anemia and lead to be a fatal course. We report the first case of AOSD with hemolytic anemia, which improved with high dose steroid therapy.
Adult ; Anemia, Hemolytic ; Arthralgia ; Disseminated Intravascular Coagulation ; Exanthema ; Fever ; Humans ; Leukocytosis ; Liver ; Lymphohistiocytosis, Hemophagocytic ; Still's Disease, Adult-Onset

Anogenital infection with human papillomavirus (HPV) is one of the most common sexually transmitted infections worldwide. The majority of HPV infections are transient and subclinical, with subsequent clearance by the immune system. However, in some individuals, especially those with impaired immunity, HPV infection may persist and result in condyloma acuminatum, pre-cancerous cervical abnormalities, as well as cervical cancer. Because of the intrinsic immunological aberrations and immunosuppressive treatment, patients with systemic lupus erythematosus (SLE) have higher prevalence of anogenital HPV infection, and SLE itself appears to be a major risk factor for HPV infection. HPV infection is sexually transmitted via genital contact; autogenesis of condyloma acuminatum without sexual contact is rare. In this case, a 27-year old virgin female with SLE was admitted to our clinic, presenting anogenital condyloma acuminata. It report that SLE patient can have a disease of anogenital HPV infection, despite the lack of sexual contact. Therefore, we recommend that patients with SLE have regular gynecological evaluations, in addition to prophylactic HPV vaccinations.
Condylomata Acuminata ; Female ; Humans ; Immune System ; Lupus Erythematosus, Systemic* ; Prevalence ; Risk Factors ; Uterine Cervical Neoplasms ; Vaccination

Rituximab is a chimeric murine-human monoclonal antibody that is directed against the specific B-cell CD20 antigen, which has recently been successfully used in active or refractory systemic lupus erythematosus (SLE) manifestations, such as nephritis, thrombocytopenia, and vasculitis. We report a case of a 25-year-old woman diagnosed with diffuse alveolar hemorrhage of SLE refractory to steroid pulse therapy. The patient was treated successfully with rituximab as a part of the immunosuppressive regimen.
Adult ; Antigens, CD20 ; B-Lymphocytes ; Female ; Hemorrhage* ; Humans ; Lupus Erythematosus, Systemic* ; Nephritis ; Thrombocytopenia ; Vasculitis ; Rituximab