title: Bronchiolitis obliterans with organizing pneumonia (BOOP) heralding anti-Jo-1-positive polymyositis.
abstract: We report a 51-year-old man who presented with 3 weeks of polyarthritis with fever, nonproductive cough, bibasilar crackles, tachypnea, and hypoxia. Initial laboratory data showed an increased erythrocyte sedimentation rate, rheumatoid factor, and anti-Jo-1 antibody. Imaging studies showed bilateral lower lobe infiltrates of the lung. A transbronchial biopsy specimen revealed characteristic findings for bronchiolitis obliterans organizing pneumonia (BOOP). About 6 months later, he developed profound proximal muscle weakness with a dramatic increase in creatine phosphokinase and aldolase and a further elevation of anti-Jo-1. Muscle biopsy specimen findings were consistent with polymyositis.This represents an unusual case in which BOOP occurred at the onset of an illness initially suggestive of rheumatoid arthritis (RA). The anti-Jo-1-positivity led to close follow up and later discovery of evolution into polymyositis. BOOP can be an early feature of polymyositis as well as RA.
authors.affiliation: Department of Medicine, Greater Baltimore Medical Center, Baltimore, Maryland 21204, USA.
authors.forename: M
authors.initials: M
authors.lastname: Xing
authors.forename: T F
authors.initials: TF
authors.lastname: Lansdale
authors.forename: C F
authors.initials: CF
authors.lastname: McNamara
authors.forename: H W
authors.initials: HW
authors.lastname: Hauptman
authors.forename: L
authors.initials: L
authors.lastname: Tao
authors.forename: R
authors.initials: R
authors.lastname: Kantor
authors.forename: R
authors.initials: R
authors.lastname: Pabla
authors.forename: G
authors.initials: G
authors.lastname: Shenoy
authors.forename: E A
authors.initials: EA
authors.lastname: Obah
authors.forename: G
authors.initials: G
authors.lastname: Bedon