BRONCHIOLITIS OBLITERANS - THE LONE MANIFESTATION OF RHEUMATOID-ARTHRITIS

The patient was a 62 year old man, who suddenly developed obstructive lung disease without a readily definable cause. He had a remarkable fa mily history of deforming rheumatoid arthritis, and a serum rheumatoid factor of 1:1,256, but with no evidence of active rheumatological dis ease. Clinical, physiological and radiologic features suggested bronch iolitis obliterans, and this was confirmed by open lung biopsy. Immune staining of tissue revealed immunoglobulin M (IgM) as well as rare im munoglobulin (IgG) containing plasma cells in a peribronchiolar locati on. Because of these findings, we suggest that this case represents br onchiolitis obliterans secondary to a rheumatoid process. This case is unusual since it appeared in a man and is the first and, so far, the only manifestation of rheumatoid arthritis. Prior studies indicate tha t the bronchiolitis obliterans of rheumatoid arthritis occurs primaril y in women and only in ongoing cases.