Migratory pulmonary infiltrates in a patient with rheumatoid arthritis.
The case history is described of an elderly man with rheumatoid arthritis receiving treatment with sulfasalazine and the cyclooxygenase-2 inhibitor celecoxib who presented with severe shortness of breath, cough, and decreased exercise tolerance. The chest radiograph showed unilateral alveolo-interstitial infiltrates and a biopsy specimen of the lung parenchyma showed changes consistent with acute eosinophilic pneumonia. Antibiotic treatment was unsuccessful, but treatment with steroids and discontinuation of sulfasalazine and celecoxib resulted in a marked clinical improvement confirmed by arterial blood gas analysis. The condition may have developed as an adverse reaction either to sulfasalazine or to celecoxib, although hypersensitivity to the latter has not previously been reported.
Mehandru
S
S
Departments of Medicine and Pathology, School of Medicine, New York University, New York, USA. saurabh_13@hotmail.com
Smith
R L
RL
Sidhu
G S
GS
Cassai
N
N
Aranda
C P
CP
D000368:Aged; D000402:Airway Obstruction / Q000139:chemically induced / Q000000981:diagnostic imaging / Q000473:pathology*; D018501:Antirheumatic Agents / Q000009:adverse effects; D001172:Arthritis, Rheumatoid / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000473:pathology*; D000068579:Celecoxib; D016861:Cyclooxygenase Inhibitors / Q000009:adverse effects; D006801:Humans; D008297:Male; D011658:Pulmonary Fibrosis / Q000473:pathology; D011720:Pyrazoles; D011859:Radiography; D012460:Sulfasalazine / Q000009:adverse effects; D013449:Sulfonamides / Q000009:adverse effects
D018501:Antirheumatic Agents; D016861:Cyclooxygenase Inhibitors; D011720:Pyrazoles; D013449:Sulfonamides; D012460:Sulfasalazine; D000068579:Celecoxib