Bucillamine-induced Pneumonitis in a Patient with Rheumatoid Arthritis-associated Interstitial Pneumonia: A Case Report and Review of the Literature

Abstract

An 81-year-old woman with rheumatoid arthritis (RA) who had been treated with bucillamine presented with dyspnea. Computed tomography of the chest showed ground-glass opacities and consolidations in both lungs and honeycombing in both basal lung areas. An elevation of the serum Krebs von den Lungen-6 level and hypoxemia were seen. Lymphocytosis with a decreased CD4/CD8 ratio was seen in the bronchoalveolar lavage fluid. A transbronchial lung biopsy specimen showed organizing pneumonia. Based on a diagnosis of bucillamine-induced pneumonitis (BIP) with RA-associated pre-existing interstitial pneumonia, she was successfully treated with the cessation of bucillamine and systemic corticosteroid therapy. The risk factors and prognosis of BIP are discussed.

A 47-Year-Old Woman With Pulmonary Nodules and Facial Hemispasms

“…Bucillamine, which is an antirheumatic drug used for the patient, can cause druginduced pneumonia. 17 Recently, bucillamine-induced severe interstitial pneumonia has been reported. Fukada et al 17 reviewed 39 cases; the oldest patient was 83 year old, the duration of bucillamine was extensive, organizing (OP), hypersensitivity (HP), or eosinophilic pneumonia were seen.…”

“…17 Recently, bucillamine-induced severe interstitial pneumonia has been reported. Fukada et al 17 reviewed 39 cases; the oldest patient was 83 year old, the duration of bucillamine was extensive, organizing (OP), hypersensitivity (HP), or eosinophilic pneumonia were seen. 17 The outcome may be good with drug cessation or systemic corticosteroid.…”

“…Fukada et al 17 reviewed 39 cases; the oldest patient was 83 year old, the duration of bucillamine was extensive, organizing (OP), hypersensitivity (HP), or eosinophilic pneumonia were seen. 17 The outcome may be good with drug cessation or systemic corticosteroid. 17 The patient's medical history and clinical negative findings left the possibility of mild RA-related diseases or chronic druginduced pneumonia, besides MMPH.…”

“…17 The outcome may be good with drug cessation or systemic corticosteroid. 17 The patient's medical history and clinical negative findings left the possibility of mild RA-related diseases or chronic druginduced pneumonia, besides MMPH. The differential diagnosis considering the clinical background and imaging is summarized in Table 1.…”

“…The differential diagnosis considering the clinical background and imaging is summarized in Table 1. 17,18 Her MMPH is being monitored by a respirologist and radiologist twice per year, and no worsening has been seen in 5 years. Her renal mass is being carefully followed-up by ultrasonography twice per year by urologists.…”