Bucillamine-induced Pneumonitis in a Patient with Rheumatoid Arthritis-associated Interstitial Pneumonia: A Case Report and Review of the Literature

• Published in: Internal Medicine Vol. 58; no. 15; pp. 2207 - 2211
• Main Authors: Fukada, Atsuki, Toyoshima, Mikio, Nozue, Tsuyoshi, Suda, Takafumi
• Format: Journal Article
• Language: English
• Published: Japan The Japanese Society of Internal Medicine 01-08-2019; Japan Science and Technology Agency
• Subjects: Aged, 80 and over; Alveoli; Anti-Inflammatory Agents, Non-Steroidal - administration & dosage; Anti-Inflammatory Agents, Non-Steroidal - therapeutic use; Arthritis, Rheumatoid - complications; Arthritis, Rheumatoid - drug therapy; Biopsy; Bronchoalveolar Lavage Fluid - cytology; Bronchus; bucillamine-induced pneumonitis; Case Report; CD4 antigen; CD8 antigen; Computed tomography; Corticosteroids; Cysteine - adverse effects; Cysteine - analogs & derivatives; Cysteine - therapeutic use; Dyspnea; Dyspnea - pathology; Female; Humans; Hypoxemia; Hypoxia - complications; Internal medicine; interstitial pneumonia; Literature reviews; Lung - pathology; Lung Diseases, Interstitial - complications; Lung Diseases, Interstitial - diagnosis; Lungs; Lymphocyte Count; Lymphocytosis; methotrexate; Pneumonia; Pneumonia - chemically induced; Pneumonia - complications; Pneumonia - diagnosis; Pneumonitis; Respiration; Rheumatoid arthritis; Risk factors; Tomography, X-Ray Computed; methotrexate; bucillamine-induced pneumonitis; rheumatoid arthritis; interstitial pneumonia
• ISSN: 0918-2918; 1349-7235
• DOI: 10.2169/internalmedicine.2515-18

An 81-year-old woman with rheumatoid arthritis (RA) who had been treated with bucillamine presented with dyspnea. Computed tomography of the chest showed ground-glass opacities and consolidations in both lungs and honeycombing in both basal lung areas. An elevation of the serum Krebs von den Lungen-6 level and hypoxemia were seen. Lymphocytosis with a decreased CD4/CD8 ratio was seen in the bronchoalveolar lavage fluid. A transbronchial lung biopsy specimen showed organizing pneumonia. Based on a diagnosis of bucillamine-induced pneumonitis (BIP) with RA-associated pre-existing interstitial pneumonia, she was successfully treated with the cessation of bucillamine and systemic corticosteroid therapy. The risk factors and prognosis of BIP are discussed.