Three female patients (M. O. age 60; N. S. age 46; K. H. age 57) with rheumatoid arthritis developed dry cough and shortness of breath, associated with pulmonary infiltration during gold therapy (Sodium thiomalate). One patient (K. H.) also developed skin rashes. The absolute white blood cell count in all three patients was within normal limits but M. O. had mild eosinophilia. No pathogens were evident in smear or culture of sputum in all three patients. The radiological appearances of the chest were similar in all three patients with bilateral coarse linear and reticular shadows predominant in middle to upper lung fields. As the possibility of gold-induced pneumonitis was considered highly probable, gold therapy was discontinued. The total dose of gold received before the development of the respiratory symptoms was 560, 605 and 200mg respectively. A transbronchial lung biopsy in M. O. showed typical interstitial pneumonia and electron microscopic examination did not disclose gold particles in the lung tissue. Pulmonary function tests showed changes consistent with restrictive lung disease. When the pulmonary function data of the three patients above was compared with that of 14 patients with cryptogenic fibrosing alveolitis, they were similar except for the fact that the maximum inspiratory esophageal pressure was less negative and the permeability, DLCO/VA, was normal in the three patients. Two to five months after the discontinuation of the gold therapy and steroid treatment, respiratory symptoms subsided but there was little change in radiological findings.
