Leflunomide-induced colitis in association with enterocutaneous fistula in an immunosuppressed patient with renal transplant and rheumatoid arthritis

Colitis in a Rheumatologic Patient

“…As such, the current mainstay for diagnosis appears to also be its treatment: symptomatic improvement after medication cessation. [1][2][3] This case demonstrates an example of leflunomide-induced colitis which should be considered in patients who present with symptoms of abdominal pain and diarrhea in the setting of leflunomide use, even months to years after medication initiation.…”

“…The decision was made to stop leflunomide, the disease-modifying antirheumatologic drug, owing to select case reports documenting rare leflunomide-induced colitis. 1,2 Symptoms improved within 2 weeks of drug cessation, with a decrease of stool frequency to 2 formed bowel movements daily, resolution of abdominal pain, and improvement of erythema on repeat flexible sigmoidoscopy.…”

Safety of Newer Disease Modifying Therapies in Multiple Sclerosis

“…Experience with medications with a similar mechanism of action or a pro-drug also allows anticipating the safety profile of a new molecule. For instance, long-term experience with leflunomide, a prodrug of teriflunomide used in rheumatoid arthritis since 1998, is reassuring except some concerns on dermatological complications (reversible alopecia areata, hidradenitis suppurativa, accelerated nodulosis, and toxic epidermal necrolysis) [172][173][174][175]; a case of colitis with enterocutaneous fistula in a severely immunocompromised patient with concomitant renal transplant, hepatitis E infection in endemic regions, and lymphadenitis and pulmonary infection by Mycobacterium Paraffinicum in a patient cotreated with methotrexate [176][177][178].…”