Leflunomide-induced toxic epidermal necrolysis in a patient with rheumatoid arthritis - 09/10/08
, Mohamed El Haouri b, Fatima Tabache a, Mohamed Baaj a, Somaya Safi a, Larbi Hadri a
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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 (60mg/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.
Le texte complet de cet article est disponible en PDF.Keywords : Leflunomide, Epidermal necrolysis, Toxic, Lyell's syndrome, Drug eruptions, Adverse effects
Plan
Vol 75 - N° 5
P. 597-599 - octobre 2008 Retour au numéro
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