Diffuse Pulmonary Injury Associated with Gold Treatment

Abstract

Two patients had diffuse, reversible pulmonary injury possibly owing to gold sodium thiomalate treatment: a 32-year-old woman with chronic inflammatory arthritis compatible with seronegative rheumatoid arthritis and a 32-year-old man with shoulder arthralgia. The patients had received 420 mg and 325 mg of gold sodium thiomalate, respectively. Cough and dyspnea began in the seventh and fifth weeks of therapy, respectively. In both patients x-ray study showed bilateral pulmonary infiltrates, with no evidence of pleural disease. The woman had no other manifestations of hypersensitivity to gold. The man had exfoliative dermatitis fever and anemia. Lung biopsies from both patients revealed lymphocytes and plasma cells infiltrating the alveolar septa and interstitial fibrosis. The woman improved slowly during four months after discontinuation of therapy. Pulmonary symptoms recurred after additional gold therapy, and again resolved when gold was discontinued. The man, treated with prednisone, showed prompt remission and remains will without medication.

Gold-Induced Pneumonitis

“…Several patients died be cause of severe hypoxaemias [9][10][11]. Chest roentgenograms show diffuse interstitial infiltrates and air space consolidation in a mixed pattern [3,4,[9][10][11][12]. Pulmonary function tests revealed a restrictive venti latory defect and decreased diffusing ca pacity [3,4,11,12], Pathological changes are non-specific and include interstitial in filtration with plasma cells and lympho cytes, interstitial and alveolar wail fibrosis and intra-alveolar desquamation of mono nuclear cells [3,4,[9][10][11][12].…”

“…Gold salt therapy is an effective treat ment for rheumatoid arthritis [1], although many side effects have been described [2], Since the publication of Winterbauer et al [3], an increasing number of patients with gold-induced pneumonitis were reported 141.…”

Lung injury due to gold treatment

“…Thus it has been described in Japan in asthma patients and in patients whose degenerative joint disease was misdiagnosed as rheumatoid arthritis (1,3,10). Furthermore, fibrosis has resolved on withdrawal of gold only to reappear on re-exposure in two cases (1).…”

Eosinophilic Pneumonia (EP) Associated with Rheumatoid Arthritis in which Drug-Induced Eosinophilic Pneumonia could be Ruled Out

“…However, the case reported by Payne and Connellan in 1980 was diagnosed based on only radiological findings without histological or BAL findings, therefore the diagnosis of EP seems uncertain (14). Yousem Ch e s t c o mp u t e d t o mo g r a p h i c s c a n s h o we d n o n -s e g me n t a l c o n s o l i d a t i o n i n t h e l e f t S 3 a n d i n c r e a s i n g d e n s i t y i n d i f f u s e l u n g f i e l d (16)(17)(18), methotrexate disease modifying anti-rheumatic drugs (DMARDs) (19,20), and nonsteroidal anti-inflammatory drugs (NSAIDs) (21). We had no proof of recurrent EP.…”