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

Abstract

INTRODUCTION:

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.

CASE REPORT:

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.

DISCUSSION:

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.

CONCLUSION:

Close monitoring for severe skin reactions is in order when using leflunomide.

• Authors: Hasna Hassikou, Mohamed El Haouri, Fatima Tabache, Mohamed Baaj, Somaya Safi, Larbi Hadri
• Journal: Joint, bone, spine : revue du rhumatisme (Joint Bone Spine) Vol. 75 Issue 5 Pg. 597-9 (Oct 2008) ISSN: 1778-7254 [Electronic] France
• PMID: 18805724 (Publication Type: Case Reports, Journal Article)

Chemical References

• Adjuvants, Immunologic
• Glucocorticoids
• Ion Exchange Resins
• Isoxazoles
• Cholestyramine Resin
• Prednisolone
• leflunomide

Topics

• 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)