Journal of the Korean Geriatrics Society  2014;18(4):232-236

doi:10.4235/jkgs.2014.18.4.232

Pulmonary Cryptococcosis in Rheumatoid Arthritis Patient Treated With Leflunomide.

Chang Kyoo BYON 1 ; Sang Woo YIM ; Jun Yong PARK ; Mee Sook ROH ; Sung Won LEE ; Won Tae CHUNG ; Sang Yeob LEE

Affiliations

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Keywords

Cryptococcosis; Leflunomide; Rheumatoid arthritis

Country

Republic of Korea

Language

Korean

MeSH

Abstract

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.