Diffuse alveolar hemorrhage after leflunomide therapy in a patient with rheumatoid arthritis
Diffuse alveolar hemorrhage after leflunomide therapy in a patient with rheumatoid arthritis
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DOI：
10.1097/rti.0b013e3181598d40
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发表时间：
2008-02-01
影响因子：
3.3
通讯作者：
Poletti, Venerino
中科院分区：
文献类型：
--
作者：
Carloni, Angelo;Piciucchi, Sara;Poletti, Venerino
我们报告的情况下，一个年轻男子，受类风湿关节炎谁开发了一个快速发作的呼吸短促，咯血，严重的弱点，约2周后，来氟米特管理。胸部X线检查显示中央双侧混浊和胸腔积液，经高分辨率计算机断层扫描证实，显示弥漫性磨玻璃和小叶间隔增厚。在急诊科入院时，还记录了微量血尿和重度贫血。根据临床放射学表现，可能发生肺出血;因此为了阐明该过程的起源，进行了完整的血清学检查，但所有抗体均为阴性。最后进行了肾活检，结果显示为低免疫性肾小球肾炎，细支气管肺泡灌洗证实了弥漫性肺泡出血。总之，诊断为来氟米特-肺-肾综合征。暂停来氟米特治疗;患者病情逐渐改善，1周后完全无症状。
We report the case of a young man, affected by rheumatoid arthritis who developed a rapid-onset short-of-breath, hemoptysis, and severe weakness, about 2 weeks after the administration of leflunomide. Chest radiography showed central bilateral opacities and pleural effusion as confirmed by the high-resolution computed tomography that demonstrated diffuse ground-glass and interlobular septal thickening as well. On admission at the Emergency Department, a microhematuria and a severe anemia were also documented. On the basis of the clinico-radiologic presentation, a pulmonary hemorrhage was likely to occur; so to clarify the origin of this process, a complete serologic examination was performed but all the antibodies were negative. Finally a renal biopsy was performed and it showed a pauci-immunologic glomerulonephritis and the bronchioloalveolar lavage confirmed the diffuse alveolar hemorrhage. In conclusion, the diagnosis of leflunomide-pulmonary-renal syndrome was rendered. The treatment with leflunomide was suspended; the conditions of the patient gradually improved and he became completely asymptomatic I week later.