Bronchiolitis obliterans organizing pneumonia associated with polymyalgia rheumatica

Abstract

The association of bronchiolitis obliterans organizing pneumonia (BOOP) with polymyalgia rheumatica is rare, and only one case has previously been described. This study reports on the case of an 80 yr-old male who presented with malaise, nonproductive cough and exertional dyspnoea for several weeks, along with a history of bilateral shoulder and pelvic girdle pain of several months' duration. The chest radiograph revealed a pneumonic infiltrate in the right lower lobe, which was unresponsive to antibiotics. Bronchoscopy, bronchoalveolar lavage and a transbronchial lung biopsy established the diagnosis of BOOP. The patient improved consistantly on steroids. As in other connective diseases, organizing pneumonia may be one of the early manifestations of polymyalgia rheumatica. Eur Respir J 1999; 13: 926±929. Polymyalgia rheumatica is a frequent clinical syndrome seen mainly in elderly patients. It often presents a diagnostic challenge, because of a large differential diagnosis including malignant neoplasms or connective tissue diseases [1]. The estimated prevalence in persons older than 50 yrs is 0.5% in the USA [1,2]. Lung involvement in polymyalgia rheumatica is rare and has been observed in the form of respiratory symptoms such as cough due to upper airway inflammation or vasculitis, pulmonary nodules and infiltrates or vasculitis of the pulmonary arteries or smaller pulmonary blood vessels [3±6]. Organizing pneumonia is a common pattern of injury and repair seen in a number of different clinical settings, mainly connective tissue disease or exposure to drugs [7,8]. The association of organizing pneumonia with polymyalgia rheumatica has been reported only once [9], hence the present report. Case reportA 80 yr-old white male presented at the outpatient clinic because of a history of several months of bilateral aches and stiffness involving the shoulders and pelvic girdle. Subsequently, he developed a nonproductive cough and slight dyspnoea on exertion. He complained of malaise, fatigue, depression, and 4 kg of weight loss in the last 2 months. The patient was a retired mason, with no history of recent respiratory tract infection. He had never smoked and had had no dermatoses or allergies. He had taken hydrocodeine for 1 month because of the cough. He denied taking any other drugs, even in the past few years.At admission, he had no fever. Physical examination of the heart and lungs was normal. The temporal arteries were neither tender nor pulseless, and he had no pain or swelling of the peripheral joints. A slight rigour of both forearms and reduced sensitivity in his lower legs were noticed. The white blood cell count (WBC), including eosinophils, was normal. The haemoglobin was 12.4 g . dL -1 (normal =14.4± 17.5 g . dL -1 ) with a normal mean corpuscular volume. The erythrocyte sedimentation rate (ESR) was 46 mm in 1 h (normal <20) and the C-reactive protein (CRP) 62 mg . L -1 (normal <10 mg . L -1 ). Serum electrophoresis showed a normal pattern. Creatine phosphokinase and levels of vitamin B12 and fo...

An Abrupt Onset of Seropositive Polyarthritis with Prominent Distal Tenosynovitis Concomitant with Bronochiolitis Obliterans Organizing Pneumonia (BOOP): Consideration of the Relationship with RS3PE Syndrome

“…BOOP is one of the major pulmonary manifestations of RA (14) and rarely occurs in other collagen diseases such as PMR (15). The characteristic pathologic findings comprise the polypoid plugs of loose, fibrous tissue filling both bronchioles and alveoli (14).…”

Rare diseases bullet 8: Organising pneumonia

“…Other disorders that have been reported to be associated with organising pneumonia include Sweet's syndrome,67 68ulcerative colitis,69 70 Crohn's disease,69polymyalgia rheumatica,71 72 thyroiditis,43Behçet's disease,43 mesangiocapillary glomerulonephritis,73 myelodysplasia,74leukaemia, myeloproliferative disorders, cancer,63 75-77common variable immunodeficiency,78 and hepatitis C 79. Since only single or small numbers of cases have been reported, it is unclear whether these represent a true association or whether the organising pneumonia results from other causes such as undiagnosed infection or drug induced reaction.…”

Cryptogenic organising pneumonia

“…Other disorders with associated organising pneumonia include: common variable hypogammaglobulinaemia and other immunoglobulin deficiencies [386][387][388]; polyarteritis nodosa [389]; Sweet syndrome [390][391][392]; polymyalgia rheumatica [393,394]; Behçet disease [395]; thyroid disease (including cancer, Basedow disease, thyroiditis, hypothyroidism) [396]; and sarcoidosis (with organising pneumonia at the periphery of granulomatous lesions) [397]. It was also reported after coronary artery bypass graft surgery [398] or in association with localised giant inflammatory polyposis of the caecum and distal ulcerative colitis [399].…”