Fatal bronchiolitis obliterans in a patient with juvenile rheumatoid arthritis receiving chrysotherapy.
Bronchiolitis obliterans has been described in adults with rheumatoid arthritis, particularly in association with D-penicillamine treatment, but to our knowledge has not been reported in juvenile rheumatoid arthritis (JRA). We describe a 12-year-old girl with JRA who developed bronchiolitis obliterans after a 6-month course of intramuscular gold. She presented with severe obstructive airway disease (FEV1, 17% predicted) unresponsive to bronchodilators, without obvious pathology on chest radiograph. Despite aggressive immunosuppressive therapy and eventual lung transplantation, she died 3 1/2 years after her initial diagnosis of JRA. Although rare, bronchiolitis obliterans must be considered in the differential diagnosis of respiratory distress in children with JRA.
Pegg
S J
SJ
Department of Pediatrics, Izaak Walton Killam Children's Hospital, Dalhousie University, Halifax, NS, Canada.
Lang
B A
BA
Mikhail
E L
EL
Hughes
D M
DM
D001171:Arthritis, Juvenile / Q000150:complications* / Q000188:drug therapy; D001989:Bronchiolitis Obliterans / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology* / Q000473:pathology / Q000601:surgery; D002648:Child; D003131:Combined Modality Therapy; D017809:Fatal Outcome; D005260:Female; D006046:Gold / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D007273:Injections, Intramuscular; D016040:Lung Transplantation; D008775:Methylprednisolone / Q000627:therapeutic use; D011241:Prednisone / Q000627:therapeutic use
D006046:Gold; D011241:Prednisone; D008775:Methylprednisolone