Chest
Selected ReportsD-Penicillamine-Induced Severe Pneumonitis
Section snippets
Case Report
A 73-year-old woman was admitted on August 23, 1980 because of fever and dyspnea. She gave a history of rheumatoid arthritis since 1978 for which she received (in 1979) several courses of gold salts, which were discontinued because of skin rash. D-penicillamine, 300 mg daily orally, was started on July 11, 1980 for treatment of recurring joint symptoms. On August 15, after a total D-penicillamine dosage of 10.5 g, she noted she was dyspneic and febrile. She was given ampicillin by her physician
Discussion
D-penicillamine has been associated with two different pulmonary reactions, namely bronchiolitis obliterans4 and diffuse miliary opacities noted on x-ray film.1, 2, 3
Bronchiolitis obliterans has been reported in several patients receiving D-penicillamine for connective tissue diseases, mainly rheumatoid arthritis.4 Clinically, these patients developed a rapidly progressive and severe airflow obstruction while taking the drug in various amounts. Roentgenographically, hyperinflation and normal
Acknowledgments
The helpful assistance of Miss Danièlle Stephan and of Miss Monique Lallemand in typing the manuscript is gratefully acknowledged.
References (11)
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Miliary pulmonary infiltrates and penicillamine.
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Iatrogenic pulmonary pathology in patients with rheumatoid arthritis against the background of D-penicillamine treatment.
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Bronchiolitis and bronchitis in connective tissue disease: a possible relationship to the use of penicillamine.
JAMA
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Am J Pathol
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Cited by (33)
Lung Injury Caused by Pharmacologic Agents
2006, Kendig's Disorders of the Respiratory Tract in ChildrenInfiltrative lung disease due to noncytotoxic agents
2004, Clinics in Chest MedicineHigh Resolution Computed Tomography of the Lungs
2004, Handbook of Systemic Autoimmune DiseasesCitation Excerpt :Other findings include nodular or ground-glass opacities, and bronchial dilatation, most frequently seen in the periphery of the lung (Oikonomou and Hansell, 2002). Pulmonary toxicity has also been described in gold salts, d-penicillamine, nonsteroidal anti-inflammatory agents (NSAIDS), and sulphasalazine (Camus et al., 1982; Khalil et al., 1993; Rosenow and Limper, 1995; Tomioka and King, 1997). Parenchymal abnormalities induced by drugs are often difficult to distinguish from more common illnesses or causes of acute exacerbation of an ongoing illness such as infection, hemorrhage, heart failure, or malignancy.
Drug-Induced Respiratory Disease in Connective Tissue Diseases
2004, Handbook of Systemic Autoimmune DiseasesCitation Excerpt :A few patients with CTD develop the accelerated variant of pulmonary fibrosis known as acute interstitial pneumonia, or the Hamman and Rich syndrome (Jacobs, 1975; Bedrossian et al., 1979). The syndrome has been reported in patients exposed to gold, methotrexate, penicillamine, or other disease-modifying drugs (Coblyn and Weinblatt, 1981; Camus et al., 1982). However, accelerated pulmonary fibrosis can also develop without reasons related to drugs (Pratt et al., 1979).
Iatrogenic drug effects in the Respiratory System
2002, Revista Portuguesa de PneumologiaPulmonary toxicity of drugs used to treat systemic autoimmune diseases
1998, Clinics in Chest Medicine
From the Service de Pneumologie, La Trouhaude