Fatal bronchiolitis obliterans associated with chrysotherapy.

In obliterative bronchiolitis, inflammation and fibrosis lead to narrowing or occlusion of bronchiolar lumina.To determine how bronchiolar structural alterations relate to lung physiology, 19 patients with a pathological diagnosis of obliterative bronchiolitis were studied. The bronchiolar inflammatory and fibrotic features were correlated to the clinical presentation, and lung function tests.Eleven patients demonstrated airflow limitation, one had a restrictive pattern and one had a mixed pattern, two had isolated gas trapping, but four had normal spirometry. Mild-to-moderate bronchiolar inflammation was invariably present. It involved 60% of bronchioles subepithelially and 54% in the adventitia. Subepithelial fibrosis was observed in 15 patients and adventitial in 12. Adventitial bronchiolar inflammation correlated with forced expiratory volume in one second and forced vital capacity and inversely correlated with residual volume. Subepithelial fibrosis inversely correlated with subepithelial and adventitial inflammation. High-resolution computed tomography in 10 patients revealed inspiratory (five out of 10) and expiratory air trapping (five out of five), ground glass opacities (seven out of 10), bronchial wall thickening (five out of 10), bronchiectasis (two out of 10) and centrilobular nodules (two out of 10).The present study suggests that inflammation and fibrosis occurs in bronchioles at different time points in the disease process, or that there is no transition between these types of pathology in the same patient. No correlation was observed between the degree of bronchiolar fibrosis and the degree of airflow limitation.

Section: Discussionmentioning

confidence: 99%

Obliterative bronchiolitis: varying presentations and clinicopathological correlation

Markopoulo¹,

Cool²,

Elliot³

et al. 2002

“…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.…”

Section: Discussionmentioning

confidence: 99%

“…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].…”

Section: Discussionmentioning

confidence: 99%

“…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].…”

mentioning

confidence: 99%

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Constrictive bronchiolitis obliterans following gold therapy for psoriatic arthritis

Schwartzman¹,

Bowie²,

Yeadon³

et al. 1995

“…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.…”

Section: Discussionmentioning

confidence: 99%

Bronchiolitis obliterans: the lone manifestation of rheumatoid arthritis?

Schwarz¹,

Lynch²,

Tuder³

1994

B Br ro on nc ch hi io ol li it ti is s o ob bl li it te er ra an ns s: : t th he e l lo on ne e m ma an ni if fe es st ta at ti io on n o of f r rh he eu um ma at to oi id d a ar rt th hr ri it ti is s? ? This case is unusual since it appeared in a man and is the first and, so far, the only manifestation of rheumatoid arthritis. Prior studies indicate that the bronchiolitis obliterans of rheumatoid arthritis occurs primarily in women and only in ongoing cases.