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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.

Revista Medica Del Instituto Mexicano Del Seguro Social
|January 6, 2011
PubMed
Abstract

Insights

Leflunomide (LEF) treatment can cause peripheral neuropathy (PN) in patients with diabetes type 2 (DM2). Electrophysiological studies are recommended before initiating LEF therapy in these individuals.

Area of Science:

  • Rheumatology
  • Neurology
  • Pharmacology

Background:

  • Leflunomide (LEF) is an approved immunomodulator for rheumatoid arthritis (RA).
  • Peripheral neuropathy (PN) is a known potential side effect of certain medications.
  • Patients with rheumatoid arthritis often have comorbidities like diabetes, requiring careful medication management.

Observation:

  • A 48-year-old female with type 2 diabetes (DM2) and RA, previously treated with multiple RA medications, was switched to LEF.
  • After four months of LEF treatment, she developed progressive symptoms of peripheral neuropathy, including dysesthesia and paresthesias.
  • Neurological examination revealed hyporeflexia and decreased muscle strength, with electrophysiological studies confirming severe polyneuropathy.

Findings:

  • The patient's neuropathy symptoms did not improve with cholestyramine treatment.
  • Electroneurophysiological and electromyography studies indicated severe segmental demyelination polyneuropathy and retrograde axonal degeneration.
  • The neuropathy predominantly affected the thoracic limbs over the pelvic limbs.

Implications:

  • This case highlights a potential adverse drug reaction of leflunomide in patients with diabetes.
  • Pre-treatment electrophysiological assessment may be crucial for identifying patients at higher risk for LEF-induced neuropathy.
  • Early detection and intervention strategies are important for managing leflunomide-associated peripheral neuropathy.

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