Pulmonary Nodules After Leflunomide Therapy in Rheumatoid Arthritis: A Case Report

Rheumatoid arthritis (RA) is a systemic autoimmune disorder with both articular and extra-articular manifestations, including rare pulmonary complications. We report a case of a 65-year-old male with long-standing RA who developed multiple cavitary pulmonary nodules following prolonged leflunomide therapy. Diagnostic evaluation excluded infectious, neoplastic, and autoimmune causes. Bronchoscopy and biopsy confirmed an acute suppurative inflammatory process with central necrosis. Discontinuation of leflunomide resulted in the resolution of pulmonary nodules. This case highlights the need for vigilance regarding potential pulmonary toxicity in RA patients receiving leflunomide and underscores the importance of prompt recognition and management of drug-induced complications.