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[Peripheral neuropathy caused by leflunomide. A case reported with a brief review]
Aquiles Antonio-Valdiviezo1, Genaro Peña-Santos, Jorge Martínez-Torres
1Hospital General de Zona 2, Tuxtla Gutiérrez, Instituto Mexicano del Seguro Social, Chiapas, Mexico.
Background:
Leflunomide (LEF) is an immunomodulator 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 old 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 not improve. Severe segmental demyelination polyneuropathy and retrograde axonal degeneration with predominance of the thoracic members over the pelvic members was reported in the electroneurophysiological and electromyography studies.
Conclusions:
It is advisable to perform electrophysiological studies in patients' with DM2 before they get treatment with LEF.
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