Formation of multiple pulmonary nodules during treatment with leflunomide

Yoshikawa, Gilberto Toshikawa; Dias, George Alberto da Silva; Fujihara, Satomi; Silva, Luigi Ferreira e; Cruz, Lorena de Britto Pereira; Fuzii, Hellen Thaís; Koyama, Roberta Vilela Lopes

doi:10.1590/s1806-37132015000004247

Cited by 16 publications

(7 citation statements)

References 9 publications

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“…Studies performed in murine fibroblasts have suggested that TNF-α antagonists can contribute to myofibroblast proliferation [10]. Interestingly, leflunomide has been associated with interstitial lung disease and pulmonary nodule formation [11]. Although the possibility that leflunomide caused intrapericardial mass cannot be excluded, our patient was most recently started on golimumab 4 months prior to this presentation, while on chronic leflunomide therapy.…”

Section: Discussionmentioning

confidence: 92%

Rheumatoid Arthritis and Cardiac Compression Caused by a Large Fibrotic Intrapericardial Mass and Effusion: A Case Report

et al. 2019

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Patient: Female, 58 Final Diagnosis: Pericardial effusion and mass Symptoms: Fatigue • lower extremity edema • shortness of breath Medication: — Clinical Procedure: Pericardiocentesis Specialty: Rheumatology Objective: Unknown ethiology Background: Pericarditis is common in rheumatoid arthritis, mostly occurring as an extra-articular manifestation of the disease. We describe a patient with stable rheumatoid arthritis who presented with a large pericardial effusion and a compressive fibrotic pericardial mass. The patient had recently started treatment with a tumor necrosis factor-alpha (TNF-α) antagonist. Case Report: The patient was a 58-year-old woman with rheumatoid arthritis who presented with right ventricular compression caused by a pericardial fibrotic mass and a large pericardial effusion. The patient did not have active arthritis at the time of presentation. She had been started on treatment with a tumor necrosis factor-alpha (TNF-α) antagonist 4 months prior to this presentation. She was successfully treated with surgical pericardiectomy and resection of the pericardial mass. Pathologic analysis of the pericardial mass demonstrated fibrosis and no evidence of active inflammation, rheumatoid arthritis, opportunistic infection, or malignancy. Conclusions: We describe a patient with stable rheumatoid arthritis who developed subacute right heart compression syndrome secondary to pericardial effusion and fibrous pericardial mass. The exact cause of pericarditis and the pericardial mass remain uncertain. There is a need for increased awareness of the association between use of TNF-α antagonists and the possible development of an intrapericardial fibrotic mass and effusion.

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Section: Discussionmentioning

confidence: 92%

Rheumatoid Arthritis and Cardiac Compression Caused by a Large Fibrotic Intrapericardial Mass and Effusion: A Case Report

et al. 2019

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“…However, research from database found series of 17 published cases in the past 30 years. [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] It presents as an evolutionary manifestation of the disease but can also constitute a circumstance of discovery. 4 The risk factor includes ILD and cutaneous vasculopathy, and the accountability of immunosuppressive medication is yet to be proven.…”

Section: Discussionmentioning

confidence: 99%

“…However, patients recovered conservatively in many reported cases. [4][5][6][7][8][9][10][11][12][13][14][15][16] Furthermore, our hospital experience proved that this condition requires supportive care, the use of supplemental oxygen and control of the underlying inflammatory process.…”

Section: Discussionmentioning

confidence: 99%

Pulmonary air leak syndrome in rheumatoid arthritis patient

Ouali

Chorfa

Hamzaoui

et al. 2022

SAGE Open Medical Case Reports

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Pulmonary air leak syndromes involve dissection of air out of the normal pulmonary airspaces and include pulmonary interstitial emphysema, pneumothorax, pneumomediastinum, pneumopericardium, pneumoperitoneum, subcutaneous emphysema and systemic air embolism. It presents as a spontaneous extension of dissecting air without a history of a procedure or penetrating injury. Pulmonary air leak syndromes are extremely rare complications of systemic autoimmune connective tissue diseases. Few cases were reported in the literature regarding rheumatoid arthritis patients. The purpose of this article is to emphasize on this rare pulmonary complication and discuss the physiopathology of the disease and the different risk factors for a better management of these patients. We report the case of a 45-year-old female, with a history of proven rheumatoid arthritis under methotrexate and steroids, who presented with a spontaneous dissecting subcutaneous emphysema, pneumothorax, pneumomediastinum and pneumoperitoneum. The patient’s condition improved after chest drainage and adjustment of her medical treatment.

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“…We searched case reports and case series published in the last 30 years with keywords including "rheumatoid arthritis, " "cavitary pulmonary nodules, " and "vasculitis" in the PubMed database (8)(9)(10)(11)(12)(13)(14)(15) usually granulomatous inflammation with necrosis in pathological specimens. Favorable outcomes were reported with corticosteroids and/or other immunosuppressive therapy except for 2 cases who died of sepsis and interstitial pneumonia.…”

Section: Alpay Kanıtez Et Al Cavitary Pulmonary Nodules In Rheumatoimentioning

confidence: 99%

Cavitary pulmonary nodules in rheumatoid arthritis; case reports and review of the literature

et al. 2018

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Formation of multiple pulmonary nodules during treatment with leflunomide

Cited by 16 publications

References 9 publications

Rheumatoid Arthritis and Cardiac Compression Caused by a Large Fibrotic Intrapericardial Mass and Effusion: A Case Report

Rheumatoid Arthritis and Cardiac Compression Caused by a Large Fibrotic Intrapericardial Mass and Effusion: A Case Report

Pulmonary air leak syndrome in rheumatoid arthritis patient

Cavitary pulmonary nodules in rheumatoid arthritis; case reports and review of the literature

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