Fatal bronchiolitis obliterans associated with chrysotherapy.

Abstract

SUMMARY We describe a patient who developed fatal bronchiolitis obliterans following gold therapy and review the relationship between rheumatoid arthritis and bronchiolitis.

Obliterative bronchiolitis: varying presentations and clinicopathological correlation

“…Gold and penicillamine therapy have been implicated in some patients [21]. The precipitating factor is unclear in patient 3, who had received both of these treatments prior to onset of symptoms.…”

Constrictive bronchiolitis obliterans following gold therapy for psoriatic arthritis

“…Three previous reports of bronchiolitis obliierans following gold therapy described middle-aged women with active, strongly seropositive rheumatoid arthritis [3][4][5]. In these women, progressive dyspnoea and cough began 2-6 months after-initiation of gold therapy.…”

“…However, the lung biopsy specimen did not reveal mucosal ulceration, suggesting a different pattern of injury. Direct lung toxicity cannot be excluded, although earlier reports regarding the pulmonary effects of gold and penicillamine tend to imply an immune mechanism [2][3][4][5].…”

“…Recognized causes include viral respiratory infection, toxic fume inhalation, certain connective tissue diseases, and bone marrow and lung transplantation [1]. Several drugs, including penicillamine [2] and gold [3][4][5], have also been associated with the disorder. However, reports implicating these agents have often been confounded by the presence of rheumatoid arthritis, which has itself been linked with bronchiolitis obliterans [6].…”

Bronchiolitis obliterans: the lone manifestation of rheumatoid arthritis?

“…This is an infrequent occurrence, and the joint manifestations appear within months to several years. However, all previous reports of bronchiolitis obliterans complicating rheumatoid arthritis occurred in ongoing, well-established disease [3,4,7,[11][12][13][14][15][16][17][18][19][20]. Of these 31 cases, which included 13 patients who were receiving penicillamine and three patients receiving gold treatment, all but two were in women.…”