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Modern Rheumatology Volume 17, 2007 - Issue 5
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CASE REPORT

Pancytopenia, including macrocytic anemia, associated with leflunomide in a rheumatoid arthritis patient

Yasuhiko ToyokawaDivision of Rheumatology, Department of Internal Medicine, Jikei University School of Medicine,3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo 105-8461, JapanCorrespondence[email protected]
,
Isamu KingetsuDivision of Rheumatology, Department of Internal Medicine, Jikei University School of Medicine,3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo 105-8461, Japan
,
Chiho YasudaDivision of Rheumatology, Department of Internal Medicine, Jikei University School of Medicine,3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo 105-8461, Japan
,
Jun YasudaDivision of Rheumatology, Department of Internal Medicine, Jikei University School of Medicine,3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo 105-8461, Japan
,
Ken YoshidaDivision of Rheumatology, Department of Internal Medicine, Jikei University School of Medicine,3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo 105-8461, Japan
,
Daitaro KurosakaDivision of Rheumatology, Department of Internal Medicine, Jikei University School of Medicine,3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo 105-8461, Japan
&
Akio YamadaDivision of Rheumatology, Department of Internal Medicine, Jikei University School of Medicine,3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo 105-8461, Japan
 show all
Pages 436-440 | Received 07 Nov 2006, Accepted 01 Jun 2007, Published online: 02 Jan 2014
 
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Abstract

A female rheumatoid arthritis patient was admitted for productive cough and general fatigue that had gradually developed after leflunomide therapy. Side effects including severe hypoxia, thrombocytopenia, lymphocytopenia, and macrocytic anemia with schistocytes (probably drug-induced megaloblastic anemia) were noted. Leflunomide-eliminating cholestyramine therapy successfully treated all conditions excluding severe hypoxia, which occurred owing to deteriorating interstitial pneumonia and complicated bacterial pneumonia following antibiotic treatment. This is a rare case of leflunomide-associated multiple hematopoietic impairments.

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