Pleuropulmonary fibrosis after long-term treatment with the dopamine agonist pergolide for Parkinson Disease.
Dopamine agonists are increasingly used in the treatment of Parkinson disease, but they may cause serious adverse effects. In December 1983, symptoms of Parkinson disease developed in a 55-year-old man with no history of pulmonary disease, smoking, or asbestos exposure. He began treatment with dopamine agonists bromocriptine mesylate (in 1984) and pergolide mesylate (in 1989). In late 2000, pulmonary symptoms developed. Chest radiographs and computed tomographic findings showed a mass in the right upper lobe and effusion. A biopsy specimen showed pleural and parenchymal fibrosis. This syndrome resolved after cessation of pergolide therapy and a switch to pramipexole dihydrochloride. This case draws attention to the association of long-term ergot dopamine agonist therapy with pleuropulmonary fibrosis, which can develop as late as 11 years after the initiation of therapy. We also review evidence that the risk of this complication is substantially lower with the newer nonergot dopamine agonists.
Tintner
Ron
R
Parkinson's Disease Center and Movement Disorders Clinic, Department of Neurology, Baylor College of Medicine, Houston, USA. rtintner@tmh.tmc.edu
Manian
Prasad
P
Gauthier
Polly
P
Jankovic
Joseph
J
D000368:Aged; D000978:Antiparkinson Agents / Q000009:adverse effects / Q000737:chemistry; D052160:Benzothiazoles; D018491:Dopamine Agonists / Q000009:adverse effects / Q000737:chemistry; D004334:Drug Administration Schedule; D006801:Humans; D008168:Lung / Q000000981:diagnostic imaging / Q000187:drug effects* / Q000473:pathology; D008297:Male; D015394:Molecular Structure; D010300:Parkinson Disease / Q000188:drug therapy; D010479:Pergolide / Q000009:adverse effects* / Q000737:chemistry; D010994:Pleura / Q000000981:diagnostic imaging / Q000187:drug effects* / Q000473:pathology; D010995:Pleural Diseases / Q000139:chemically induced* / Q000000981:diagnostic imaging / Q000473:pathology; D000077487:Pramipexole; D011658:Pulmonary Fibrosis / Q000139:chemically induced* / Q000000981:diagnostic imaging / Q000473:pathology; D013844:Thiazoles / Q000627:therapeutic use; D014057:Tomography, X-Ray Computed
D000978:Antiparkinson Agents; D052160:Benzothiazoles; D018491:Dopamine Agonists; D013844:Thiazoles; D010479:Pergolide; D000077487:Pramipexole