Bronchiolitis and Bronchitis in Connective Tissue Disease

Abstract

Rapid onset of severe and irreversbile airflow obstruction developed in two women. One had eosinophilic fasciitis and the other had rheumatoid arthritis. Both were treated with penicillamine. In the first patient, aged 42 years, dyspnea developed after six months of therapy. Her roentgenogram showed hyperinflation. Forced vital capacity expired in one second (FEV1/FVC%) decreased from 75% to 40%, and the residual volume increased by 1 L. In the second patient, aged 54 years, cough and dyspnea developed after ten months of therapy. The FEV1/FVC% was 56%, the FEV1 was 0.9 L, and the roentgenogram was normal. Lung biopsy specimens demonstrated severe and widespread bronchiolitis. An association between obliterative bronchiolitis and rheumatoid arthritis has been reported. Penicillamine may impair healing of bronchiolitis in such patients.

Bronchiolitis obliterans in a patient with localized scleroderma treated with D-penicillamine

“…However, it has been postulated that patients with rheumatoid arthritis may be Patients with systemic sclerosis are well-known to develop restrictive ventilatory defects and impaired gas transfer, due to fibrosing alveolitis [26,27] and a preferential involvement of small lung vessels [28]. Few cases of systemic sclerosis have been reported with biopsy proven BO [5,16]. In one case, the symptoms of BO started before [16], and in another during treatment with D-penicillamine [5].…”

“…Few cases of systemic sclerosis have been reported with biopsy proven BO [5,16]. In one case, the symptoms of BO started before [16], and in another during treatment with D-penicillamine [5].…”

“…A wide spectrum of pulmonary complications, such as bronchiolitis obliterans (BO), interstitial pneumonitis, alveolar haemorrhage and bronchospasm have been described [1]. However, almost all pulmonary side-effects except pulmonary haemorrhage [3,4] are found exclusively in patients treated with D-penicillamine for rheumatoid arthritis or progressive systemic sclerosis [1,[5][6][7][8][9][10][11][12][13][14][15][16]. Furthermore, it is well-known that BO may occur in patients with rheumatoid arthritis who have never received Dpenicillamine [15].…”

Obstructive Lung Disease from Acute Sulfur Dioxide Exposure

“…with persistent dyspnea on exertion and productive cough continued. Digoxin and predni sone were stopped; methylxanthines were contin ued and he was referred to our laboratory on July 16,1970.…”

“…Bronchiolitis obliterans has been de scribed following infections [6,7,13,14], possibly with rheumatoid disease [15,16], toxic inhalation [3], and not uncommonly it is idiopathic. It was first described by Lange [17] in 1901 with the most recent and ex tensive reviews by McAdams [6] and Gosink et a!.…”