title: Fatal bronchiolitis obliterans in a patient with juvenile rheumatoid arthritis receiving chrysotherapy.
abstract: 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.
authors.affiliation: Department of Pediatrics, Izaak Walton Killam Children's Hospital, Dalhousie University, Halifax, NS, Canada.
authors.forename: S J
authors.initials: SJ
authors.lastname: Pegg
authors.forename: B A
authors.initials: BA
authors.lastname: Lang
authors.forename: E L
authors.initials: EL
authors.lastname: Mikhail
authors.forename: D M
authors.initials: DM
authors.lastname: Hughes
mesh_terms: 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
chemical_list: D006046:Gold; D011241:Prednisone; D008775:Methylprednisolone