Pneumotox » Drug » Leflunomide

Leflunomide

The mere existence of the entity 'leflunomide pneumonitis' is disputed (PMID 26980577). Somes cases were receiving methotrexate concomitantly. The condition is rare if it at all exists outside Japan (PMID 26980577)

Last update : 20/03/2016

I.a Pneumonitis (ILD), acute and/or severe (may cause ARDS)

I.b Pneumonitis (ILD)

I.c Eosinophilic pneumonia (pulmonary infiltrates and eosinophilia)

I.d Organizing pneumonia pattern (an area or areas of consolidation on imaging)

I.l Diffuse alveolar damage (DAD) (see alsoo under IIb and XVf)

I.n Pulmonary alveolar proteinosis (PAP)

I.q Pulmonary nodulosis

I.y Progression, acceleration or exacerbation of preexisting ILD/fibrosis

I.z An area or areas of consolidation

IV.d Cough (lone)

V.m Pleuropericarditis - Pleuropericardial effusion (ANA unknown or negative)

VI.b Pulmonary arterial hypertension

X.a DRES syndrome - DRESS-like reaction

X.d Lupus - Lupus syndrome (see also Vd)

XV.a Path: NSIP-cellular pattern (see also Ia, Ib)

XV.c Path: Organizing pneumonia (OP/BOOP) pattern (see also Id)

XV.f Path: Diffuse alveolar damage (DAD-pattern) (see also IL)

XV.i Path: Pneumocyte atypia (reactive epithelial cells) (a.k.a. the "Napoleon Hat" sign)

XVII.g Tuberculosis (pulmonary, pulmonary, extrapulmonary or disseminated). Reactivation or de novo

XIX.a BAL: An excess proportion of lymphocytes

Diagnosing DIRD

Drug and radiation history

Drug singularity - Correct identification of the drug

Consistent timing of exposure v. onset of symptoms

Clinical, imaging, BAL, pathological pattern consistent with the specific drug

Careful exlusion of another cause

Remission of symptoms with removal of drug

Recurrence with rechallenge (rarely advisable)

Causality assessment

More detailed checklist

The Drug-Induced Respiratory Disease Website

Philippe Camus, M.D.

Dijon, France