Leflunomide-induced toxic epidermal necrolysis in a patient with rheumatoid arthritis.

Leflunomide is an immunomodulating agent with proven efficacy in rheumatoid arthritis. Although its overall safety profile is good, a few cases of toxic epidermal necrolysis have been reported.
This 36-year-old woman had rheumatoid arthritis that proved refractory to sulfasalazine and methotrexate, which were used successively in combination with symptomatic drugs. Leflunomide was started. A maculopapular rash and a fever developed 2 weeks later. The skin lesions spread rapidly to most of the body, and ulcers of the ocular and oral mucosa appeared. Leflunomide was stopped. Cholestyramine washout and prednisolone (60 mg/day) were given. The skin lesions healed over the next month. Punctate keratitis with keratinization of the cornea led to complete loss of vision.
The main adverse effects of leflunomide consist of diarrhea, nausea, liver enzyme elevation, hypertension, alopecia, and allergic skin reactions. A few cases of severe skin reactions such as toxic epidermal necrolysis have been reported. They require immediate discontinuation of the drug and a washout procedure to hasten drug elimination from the body.
Close monitoring for severe skin reactions is in order when using leflunomide.
AuthorsHasna Hassikou, Mohamed El Haouri, Fatima Tabache, Mohamed Baaj, Somaya Safi, Larbi Hadri
JournalJoint, bone, spine : revue du rhumatisme (Joint Bone Spine) Vol. 75 Issue 5 Pg. 597-9 (Oct 2008) ISSN: 1778-7254 [Electronic] France
PMID18805724 (Publication Type: Case Reports, Journal Article)
Chemical References
  • Adjuvants, Immunologic
  • Glucocorticoids
  • Ion Exchange Resins
  • Isoxazoles
  • Cholestyramine Resin
  • Prednisolone
  • leflunomide
  • Adjuvants, Immunologic (adverse effects)
  • Adult
  • Arthritis, Rheumatoid (complications, drug therapy)
  • Cholestyramine Resin (therapeutic use)
  • Female
  • Glucocorticoids (therapeutic use)
  • Humans
  • Ion Exchange Resins (therapeutic use)
  • Isoxazoles (adverse effects)
  • Prednisolone (therapeutic use)
  • Stevens-Johnson Syndrome (drug therapy, etiology, pathology)

Join CureHunter, for free Research Interface BASIC access!

Take advantage of free CureHunter research engine access to explore the best drug and treatment options for any disease. Find out why thousands of doctors, pharma researchers and patient activists around the world use CureHunter every day.
Realize the full power of the drug-disease research network!

Choose Username:
Verify Password:
Type Validation Code Shown: