Fatal bronchiolitis obliterans in a patient with juvenile rheumatoid arthritis receiving chrysotherapy
Pegg, S.J.; Lang, B.A.; Mikhail, E.L.; Hughes, D.M.
Journal of Rheumatology 21(3): 549-551
1994
ISSN/ISBN: 0315-162X PMID: 8006901 Document Number: 438649
Bronchiolitis obliterans has been described in adults with rheumatoid arthritis, particularly in association with D-penicillamine treatment, but to our knowledge has not been reported in juvenile rheumatoid arthritis (JRA). We describe a 12-year-old girl with JRA who developed bronchiolitis obliterans after a 6-month course of intramuscular gold. She presented with severe obstructive airway disease (FEV-1, 17% predicted) unresponsive to bronchodilators, without obvious pathology on chest radiograph. Despite aggressive immunosuppressive therapy and eventual lung transplantation, she died 3 1/2 years after her initial diagnosis of JRA. Although rare, bronchiolitis obliterans must be considered in the differential diagnosis of respiratory distress in children with JRA.