BRONCHIOLITIS OBLITERANS ORGANIZING PNEUMONIA AS THE FIRST MANIFESTATION OF POLYMYOSITIS

Bronchiolitis obliterans organizing pneumonia (BOOP) preceding polymyo sitis is rare, In this report, a 51-year-old patient with fever, nonpr oductive cough, and dyspnea had bilateral basal interstitial infiltrat es on chest roentgenogram. Open lung biopsy was consistent with BOOP. Prednisone therapy led to improvement, but 8 weeks later, fever, cough , and weakness of the arms and legs developed because the patient had not been compliant with the prednisone regimen, The creatine kinase (C K), the macrophage inflammatory protein (MIP-1), and the tumor necrosi s factor (TNF-alpha) were elevated, Anti-Jo-1 antibody was not present , Quadriceps femoris muscle biopsy was compatible with polymyositis, A fter a second course of corticosteroid therapy, the patient became afe brile, the dyspnea resolved, the pulmonary infiltrates decreased, and the muscle strength improved, The serum CK, MIP-1, and TNF-alpha level s declined significantly, This is only the second reported case of BOO P preceding polymyositis, Patients with idiopathic BOOP should have fo llow-up for the possible development of connective tissue disorders in cluding polymyositis.