Abstract
Bucillamine [Bc; N-(2-mercapto-2-methylpropionyl)-L-cysteine] is one of the anti-rheumatic drugs which was developed in Japan. Interstitial pneumonitis induced by Bc has been reported in one patient with rheumatoid arthritis (RA). In this report, we describe another patient with RA who developed Bc-induced interstitial pneumonitis.
A sixty-two year-old female had developed RA since 1983. She had histories of adverse effects of anti-rheumatic drugs such as gold sodium thiomalate (genaralized skin rash) and D-penicillamine (fever). Although she had been well controlled by salicylazosulphapyridine since June, 1986, her disease relapsed on Jan., 1990. The treatment with Bc (200→300mg/day) was started on April, 1990. Her disease activity improved 3 months after the begining of Bc, but she developed dyspnea on July, 1990. She had hypoxemia (PO260Torr). Chest X-ray studies, pulmonary function tests and 67Ga-scingaraphy of the lung were compatible with active, diffuse interstitial pneumonitis. Lymphocyte stimulation test using Bc was negative, and CD4/CD8 ratio in bronchoalveolar lavage fluid lymphocytes was normal. Interstitial inflammation with mononuclear cell infiltrations was observed in the specimen biopsied from her lung. Her symptoms persisted after the termination of Bc, but prednisolone (50mg/day) rapidly improved her symptoms and laboratory test results.
