Sj. Pegg et al., FATAL BRONCHIOLITIS OBLITERANS IN A PATIENT WITH JUVENILE RHEUMATOID-ARTHRITIS RECEIVING CHRYSOTHERAPY, Journal of rheumatology, 21(3), 1994, pp. 549-551
Bronchiolitis obliterans has been described in adults with rheumatoid
arthritis, particularly in association with D-penicillamine treatment,
but to our knowledge has not been reported in juvenile rheumatoid art
hritis (JRA). We describe a 12-year-old girl with JRA who developed br
onchiolitis obliterans after a 6-month course of intramuscular gold. S
he presented with severe obstructive airway disease (FEV(1) 17 % predi
cted) unresponsive to bronchodilators without obvious pathology on che
st radiograph. Despite aggressive immunosuppressive therapy and eventu
al lung transplantation, she died 31/2 years after her initial diagnos
is of JRA. Although rare, bronchiolitis obliterans must be considered
in the differential diagnosis of respiratory distress in children with
JRA.