Gugenberger C, Donner P, Naami A, Berges W
[Persistent diarrhea and loss of weight during therapy with leflunomide] [Case Reports, English Abstract, Journal Article]
Dtsch Med Wochenschr 2008 Aug; 133(34-35):1730-2.
HISTORY AND CLINICAL FINDINGS: A 55-year-old woman had suffered from diarrhea and a weight loss of 15 kg over the previous six months. Neither the search for a causative pathogen nor coloscopy had provided a diagnosis. She was known to have type 1 diabetes mellitus, previous Hashimoto's thyroiditis, rheumatoid arthritis treated with leflunomide and drug- treated arterial hypertension. She was in a reduced general condition. Investigations:: The results of extensive initial diagnostic tests were unremarkable. Biopsies obtained at colonoscopy revealed marked lymphocytic colitis (LC). TREATMENT AND COURSE: When leflunomide was discontinued and replaced by salazosulfapyridine (sulfasalazine) and the steroid budesonide, the diarrhea ceased within a few days and the LC was no longer evident histologically after three months.
CONCLUSIONS: Leflunomide can in rare cases cause a LC. that can quickly regress once the drug has been stopped. If the findings on colonoscopy in a case of otherwise unexplained diarrhea are grossly normal, a biopsy should be taken to rule out microscopic colitis.
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