1997 Volume 19 Issue 3 Pages 232-236
We report a 68-year-old case of bucillamine-induced interstitial pneumonitis. She had been suffering from rheumatoid arthritis (RA) since 1995, and had been treated with bucillamine since April, 1996 with good result. However, after taking bucillamine for about 80 days, dry cough and dyspnea on effort developed and was admitted. Those manifestations worsened daily. Pulmonary function test revealed a restrictive pattern and blood gas analysis showed hypoxia. Interstitial changes were seen in bilateral lung fields on X-ray and computed tomography (CT) film. RA activity was low. We performed bronchoalveolar lavage (BAL) and trance bronchial lung biopsy (TBLB). A drug lymphocyte stimulating test (DLST) using bucillamine was done both with blood and BAL. Although the former was negative, the latter was positive. The CD4/CD8-ratio of BAL was remarkably low, and lymphocytes invasion to alveolar walls was found in TBLB specimens. We diagnosed her lung injury was bucillamine-induced interstitial pneumonitis, and started steroid therapy with 50mg/day of PSL. Her pulmonary function recovered and clinical manifestations disappeared quickly. Not a small number of cases of lung injury during bucullamine therapy for rheumatoid arthritis have been reported since 1989, but its mechanism remains unknown. This case suggests that the contribution of hypersensitivity reaction (Cooms & Gell type IV) to the development of bucillamine-inducted interstitial pneumonitis.
