BUCILLAMINE-INDUCED PULMONARY INJURY OCCURS WITH IMMUNOGLOBULIN DECREASE

We describe pulmonary involvement in 3 patients with rheumatoid arthri tis treated with bucillamine. In all 3, synovitis was in remission. Th e common radiological characteristic was mottled dense infiltrates, in which were air bronchograms, in the bilateral central lung, sparing t he periphery. Lung biopsies in 2 cases revealed organizing exudates in the alveolar ducts and alveoli, and cellular infiltration into alveol i and septa. Serum immunoglobulin (Ig) levels decreased markedly at th e time of involvement. After discontinuation of bucillamine, lung inju ry resolved without exacerbation of synovitis and Ig levels increased. A mechanism involving decreased Ig concentration is suggested.