류마티스관절염 환자에서 레플루노마이드 사용 중 발생한 크립토코쿠스 폐렴 1예 = Pulmonary Cryptococcosis in Rheumatoid Arthritis Patient Treated With Leflunomide

다국어 초록 (Multilingual Abstract)

Leflunomide, a disease-modifying antirheumatic drug, is effective for rheumatoid arthritis as monotherapy or combination therapy with methotrexate. The most common adverse effects are diarrhea, dyspepsia, nausea, abdominal pain, oral ulcer, hepatotoxicity, skin rash, hypertension, weight loss, and interstitial lung disease. The occurrence of pulmonary cryptococcosis in leflunomide treatment has not been reported in Korea. A 74-year-old woman was admitted to hospital due to asymptomatic pulmonary nodule. She was diagnosed rheumatoid arthritis and treated with leflunomide 5 months ago due to treatment failure with methotrexate, hydroxychloroquine, and sulfasalazine. Chest radiograph and computed tomography showed solitary pulmonary nodule in her right lower lung. Pulmonary cryptococcosis was confirmed by needle biopsy of lung stained with Gomori methenamine silver and mucicarmine. The lesion was improved after antifungal therapy for 3 months.

참고문헌 (Reference)

1 정혜련, "전신홍반루푸스 환자에 동반된 파종성 효모균증 1예" 대한류마티스학회 17 (17): 194-199, 2010

2 전지민, "신이식 환자에서 발생한 무증상 파종성 크립토콕쿠스증 1예" 대한신장학회 29 (29): 310-314, 2010

3 이규철, "류마티스 관절염 환자에 발생한 폐효모균증 1예" 대한류마티스학회 10 (10): 12-194, 2003

4 Gladman DD., "The nature and outcome of infection in systemic lupus erythematosus" 11 : 234-239, 2002

5 Dutta S., "The efficacy and safety of tacrolimus in rheumatoid arthritis" 3 : 283-291, 2011

6 Baddley JW., "Pulmonary cryptococcosis in patients without HIV infection : factors associated with disseminated disease" 27 : 937-943, 2008

7 Ravindran V., "Pulmonary cavitation : a rare complication of leflunomide therapy" 5 : 85-88, 2007

8 Tomos P., "Pulmonary aspergillosis in chronic leflunomide treatment" 13 : 282-283, 2012

9 Ulusoy H., "Pulmonary abscess due to leflunomide use in rheumatoid arthritis : a case report" 25 : 139-142, 2005

10 Shrestha RK., "Pneumonia due to Cryptococcus neoformans in a patient receiving infliximab : possible zoonotic transmission from a pet cockatiel" 49 : 606-608, 2004

11 Hocevar A., "Leflunomide-associated tuberculosis?" 45 : 228-229, 2006

12 Takeishi M., "Leflunomide induced acute interstitial pneumonia" 32 : 1160-1163, 2005

13 Osiri M., "Leflunomide for the treatment of rheumatoid arthritis : a systematic review and metaanalysis" 30 : 1182-1190, 2003

14 Cannon GW., "Leflunomide" 30 : 295-309, 2004

15 Casadevall A., "Harrison’s principles of internal medicine. 18th ed" McGraw-Hill 1648-1651, 2011

16 Eng RH., "Cryptococcal infections in patients with acquired immune deficiency syndrome" 81 : 19-23, 1986

17 Salomon-Escoto KI., "Assessment of control of rheumatoid arthritis disease activity" 25 : 497-507, 2011

18 김현옥, "60세 이상에서 발생하는 류마티스 관절염의 임상적 특징" 대한노인병학회 14 (14): 227-233, 2010