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Leflunomide toxicity — SCE Rheumatology MCQ

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EasyRheumatological pharmacologyLeflunomide toxicitySCE Rheumatology

A 55-year-old man on leflunomide for psoriatic arthritis develops weight loss, diarrhoea and hypertension. Examination shows no synovitis is present. Investigations show ALT is 186 IU/L and blood pressure is 168/98 mmHg. What is the most likely diagnosis?

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Correct answer: C — Leflunomide toxicity

The timing, drug exposure and investigation pattern support Leflunomide toxicity. The alternatives share some symptoms but do not match the adverse-effect profile as closely. DMARD toxicity should be considered whenever new systemic symptoms develop during immunosuppressive therapy.

Reference: BNF; SPS DMARD monitoring guidance; BSR DMARD prescribing guideline