The skin biopsy showed features of interface dermatitis.Ĭase 4 A 52 year old male patient presented with pruritic skin rashes, fever, diarrhea, nausea and abdominal pain since 5 days. The patient was treated with systemic steroids and supportive medications as required, but however, she developed exfoliative dermatitis. Lab investigations revealed elevated LFT′s, WBC count and ESR. She developed jaundice, abdominal pain, diarrhea and vomiting during the hospital stay. On examination, she had generalized erythematous macules and papules, edema of the face and enlarged posterior cervical lymph nodes. She was started on oral leflunomide for her arthritis, a month earlier. The patient′s condition improved with systemic steroids and supportive medications.Ĭase 3 A 50-year-old female patient presented with pruritic skin rashes and fever for the past 10 days. Lab investigations revealed elevated WBC count and eosinophilia. Crusting of lips, edema of hands and feet, congestion of eyes and left axillary lymphadenopathy were observed. He had diffuse erythema over the trunk, multiple tiny papules and few pustules over the trunk and extremities. On examination, he was febrile with tachycardia. Four weeks prior to the symptoms, all other medications were withdrawn and he was started on the standard dosing regimen of leflunomide for arthritis. After initial improvement with steroids and other supportive treatment, her condition worsened and she developed toxic epidermal necrolysis, with a fatal outcome after a week.Ĭase 2 A 24-year-old male patient presented with pruritic skin rashes, fever, loss of appetite, generalized weakness and swelling of lips for the last 15 days. Lab investigations revealed elevated WBC count and LFT. She also had right-sided minimal pleural effusion and hepatomegaly. On examination, she had icterus, generalized macular and papular rash and a few purpuric lesions over the legs. Six weeks prior to the admission to the hospital, she was treated with leflunomide (100 mg for 3 days, followed by 20 mg once daily) and rofecoxib (25 mg once daily) for arthralgia. Ĭase 1 A 21-year-old female patient was admitted to the hospital with history of fever, jaundice and pruritic skin rashes for the last 20 days. We report five cases of severe CADR induced by leflunomide. It has been reported to cause various CADRs including SJS, TEN and EM, in less than 1% of the patient population. Leflunomide is a new immunomodulating agent and disease-modifying antirheumatic drug with anti-inflammatory and immunosuppressive activity, used in the treatment of active rheumatoid arthritis. Many drugs including ciprofloxacin, carbamazepine, dapsone, isoniazid, clindamycin, diclofenac, rifampicin and zidovudine are known to cause severe cutaneous reactions. The clinical spectrum of CADRs ranges from pruritus to severe life-threatening reactions like erythema multiforme (EM), Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN) and drug hypersensitivity syndrome (DHS). Cutaneous adverse drug reactions (CADRs) are the most prominently seen ADRs.
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