CASE REPORT - Arava-induced toxic epidermal necrolysis in a patient with RA

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Joint Bone Spine. 2008 Oct;75(5):597-9. Epub 2008 Sep 20.

Leflunomide-induced toxic epidermal necrolysis in a patient with

rheumatoid arthritis.

Hassikou H, El Haouri M, Tabache F, Baaj M, Safi S, Hadri L.

Service de Médecine Interne, Hôpital Militaire Moulay Ismail, Meknes, Morocco.

INTRODUCTION: Leflunomide is an immunomodulating agent with proven

efficacy in rheumatoid arthritis. Although its overall safety profile

is good, a few cases of toxic epidermal necrolysis have been reported.

CASE REPORT: This 36-year-old woman had rheumatoid arthritis that

proved refractory to sulfasalazine and methotrexate, which were used

successively in combination with symptomatic drugs. Leflunomide was

started. A maculopapular rash and a fever developed 2 weeks later. The

skin lesions spread rapidly to most of the body, and ulcers of the

ocular and oral mucosa appeared. Leflunomide was stopped.

Cholestyramine washout and prednisolone (60 mg/day) were given. The

skin lesions healed over the next month. Punctate keratitis with

keratinization of the cornea led to complete loss of vision.

DISCUSSION: The main adverse effects of leflunomide consist of

diarrhea, nausea, liver enzyme elevation, hypertension, alopecia, and

allergic skin reactions. A few cases of severe skin reactions such as

toxic epidermal necrolysis have been reported. They require immediate

discontinuation of the drug and a washout procedure to hasten drug

elimination from the body.

CONCLUSION: Close monitoring for severe skin reactions is in order

when using leflunomide.

PMID: 18805724

http://www.ncbi.nlm.nih.gov/pubmed/18805724

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