Bronchiolitis obliterans and rheumatoid arthritis. Report of a case in a Chinese patient on d-penicillamine and review of the literature.
Rheumatoid arthritis is the commonest connective tissue disease associated with bronchiolitis obliterans, a clinico-pathologic entity of bronchiolar inflammation and fibrosis reflecting injury to the small airways, and presenting with symptoms and signs of small airways obstruction. It may arise de novo or as a complication of therapy due to d-penicillamine, when a distinct histologic picture of bronchiolar constriction without intraluminal inflammatory polyps appeared to be predominant in most reported cases. This condition is associated with a high morbidity and mortality, and apart from cessation of d-penicillamine, there are no standard recommendations for treatment. Response to various immunosuppressive agents, including corticosteroid, azathioprine, and cyclophosphamide, had been variable and unsatisfactory. We report a case of bronchiolitis obliterans in a Chinese female treated with d-Penicillamine for rheumatoid arthritis with the first documented response to corticosteroid alone, and review the literature on this subject.
Department of Medicine, Nethersole Hospital, Hong Kong.
L Y
LY
Yam
R
R
Wong
D000328:Adult; D001172:Arthritis, Rheumatoid / Q000150:complications* / Q000188:drug therapy / Q000208:ethnology; D001706:Biopsy; D001989:Bronchiolitis Obliterans / Q000139:chemically induced* / Q000175:diagnosis / Q000208:ethnology; D001999:Bronchoscopy; D002681:China / Q000208:ethnology; D005260:Female; D006723:Hong Kong; D006801:Humans; D008168:Lung / Q000473:pathology; D010396:Penicillamine / Q000009:adverse effects*
D010396:Penicillamine