SUGGESTIVE EVIDENCE FOR BROMOCRIPTINE-INDUCED PLEURISY

Pleurisy of initially unknown origin was found in a patient who was tr eated with bromocriptine for Parkinson's disease for 6 years. At prese ntation, bilateral pleural thickening existed that caused severe restr iction of pulmonary function. There were an elevated erythrocyte sedim entation rate, polyclonal hypergammaglobulinaemia, increased levels of acute phase proteins and anaemia. After withdrawal of the bromocripti ne the patient's complaints as well as the laboratory parameters marke dly improved. Further loss of pulmonary function did not occur, Howeve r, the pleural thickening did not resolve, not even upon subsequent co rticosteroid treatment, probably due to fibrosis. Together, these find ings strongly suggest a causative role of bromocriptine. The results o f the laboratory studies suggested an immunopathogenetic mechanism, bu t in vitro lymphocyte-proliferation studies and skin patch tests with bromocriptine were negative. Bromocriptine should be considered as a c ause of pleurisy. The drug must be stopped immediately upon the occurr ence of pleural thickening in order to prevent impairment of pulmonary function. in addition, periodic laboratory and X-ray studies in patie nts on long-term bromocriptine treatment should be considered.