Pulmonary nodules in rheumatoid arthritis: the case of leflunomide

Rheumatoid arthritis (RA) is a chronic autoimmune disease primarily affecting joints. Extra-articular manifestations, including pulmonary involvement, significantly contribute to morbidity and mortality. Disease-modifying antirheumatic drugs are crucial for RA treatment but may also have pulmonary side effects. The differentiation between pulmonary RA manifestations, infection in the immunosuppressed patient, and drug-induced pulmonary toxicity remains a diagnostic and therapeutic challenge. This report presents a rare case of accelerated pulmonary nodulosis associated with leflunomide therapy, emphasizing the need for careful differential diagnosis in immunosuppressed patients.