Peripheral neuropathy caused by leflunomide. A case reported with a brief review
Main Article Content
Keywords
Peripheral neuropathy, Leflunomide, Arthritis, rheumatoid, Diabetes
Abstract
Background: Leflunomide (LEF) is an immunomodu-lator derived from isoxazole It is an approved drug in the rheumatoid arthritis (RA). The peripheral neuropathy (PN) is a recognized side effect of some medications.
Clinical case: A 48 years woman with diabetes type 2 (DM2) and RA; with serum negative rheumatoid factor. She got nonsteroidal anti-inflammatories drugs, corticosteroid, methotrexate, sulfasalazine and chloroquine. Despite this, she was clinically within the functional class III and data of osteopenia. The treatment was switched to LEF, chloroquine and prednisone. After four months, she began with dysesthesia in the left cubital area, paresthesias in her right knee; and then in a progressive pattern others paresthesias, hyporeflexia and a decrease in the muscular strength. She was treated with cholestyramine, but her neuropathy did no improve. Severe segmental desmyelination polyneuropathy and retrograde axonal degeneration with predominance of the thoracic members over the pelvic members was reported in the electroneuro-physiological and electromyography studies.
Conclusions: It is advisable to perform electrophysiological studies in patients’ with DM2 before
References
Cantú-Brito C, Baizábal-Carvallo F, Aldrete-Velasco J, Chávez-Güitrón E. Aplicaciones clínicas del ácido tióctico (ácido alfa-lipoico) en pacientes con neuropatía diabética sintomática: revisión. Med Int Mex 2007;23(2):151-158.
Richards BL, Spies J, McGill N, Richards GW, Vaile J, Bleasel JF, et al. Effect of leflunomide on the peripheral nerves in rheumatoid arthritis. Intern Med J 2007;37(2):101-107.
Bonnel RA, Graham DJ. Peripheral neuropathy in patients treated with leflunomide. Clin Pharmacol Ther 2004;75(6):580-585.
Metzler C, Arlt AC, Gross WL, Brandt J. Peripheral neuropathy in patients with systemic rheumatic diseases treated with leflunomide. Ann Rheum Dis 2005;64(12):1798-1800.
Hill CL. Leflunomide-induced peripheral neuropathy: rapid resolution with cholestyramine wash-out. Rheumatology 2004;43(6):809.
Carulli MT, Davies UM. Peripheral neuropathy: an unwanted effect of leflunomide? Rheumatology 2002;41(8):952-953.
Bharadwaj A, Haroon N. Peripheral neuropathy in patients on leflunomide. Rheumatology 2004; 43(7):934.
Navarro-Cano G, Esquivel-Valerio JA, Madrigal-Medina KM, Morales-Zambrano R, Skinner-Taylor CM, Galarza-Delgado DA, et al. Tratamiento de artritis reumatoide refractaria con leflunomida. Rev Mex Reumatol 2002;17(4):241-246.
Martin K, Bentaberry F, Dumoulin C, Longy-Boursier M, Lifermann F, Haramburu F, et al. Neuropathy associated with leflunomide: a case series. Ann Rheum Dis 2005;64(4):649-650.
Gabelle A, Antoine JC, Hillaire-Buys D, Coudeyre E, Camu W. Leflunomide-related severe axonal neuropathy. Rev Neurol 2005;161(11):1106-1109.
Kho LK, Kermode AG. Leflunomide-induced peripheral neuropathy. J Clin Neurosci 2007;14(2):179-181.