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[A case of interstitial pneumonia in polymyositis difficult to distinguish from gold pneumonitis]
K Maeda1, K Komuta, K Hasegawa
1Department of Second Internal Medicine, Teishin Hospital, Osaka, Japan.
Abstract:
Rheumatoid arthritis was diagnosed in a 48-year-old woman. She received a gold compound, and 4 weeks after the start of that therapy, interstitial pneumonia appeared. Findings from a muscle biopsy, and high serum CPK and LDH levels indicated that she suffered from polymyositis rather than rheumatoid arthritis. The result of a drug lymphocyte stimulation test (DLST) for the gold compound was more than 200%. Because the usefulness of the DLST for the gold compound in the diagnosis of gold pneumonitis is not thoroughly established, the DLST was also done in patients with rheumatoid arthritis who were receiving the gold compound without side effects, and in normal subjects. Many of the rheumatoid arthritis patients and some of the normal subjects had a positive response to the gold compound. Therefore a positive response on the DLST for the gold compound does not always support the diagnosis of gold pneumonitis.
Insights
A drug lymphocyte stimulation test (DLST) for gold compounds showed a positive result in a patient with suspected gold pneumonitis. However, positive DLST results were also common in rheumatoid arthritis patients and normal subjects, questioning its diagnostic value for gold pneumonitis.
Area of Science:
- Immunology
- Rheumatology
- Pulmonology
Background:
- Gold compounds have been used to treat rheumatoid arthritis.
- Interstitial pneumonia is a potential adverse effect of gold therapy.
- Polymyositis can present with elevated creatine phosphokinase (CPK) and lactate dehydrogenase (LDH).
Observation:
- A patient diagnosed with rheumatoid arthritis developed interstitial pneumonia and polymyositis after gold compound treatment.
- The patient exhibited a high positive response (>200%) on a drug lymphocyte stimulation test (DLST) for the gold compound.
- DLST was performed on rheumatoid arthritis patients without side effects and healthy controls to assess test specificity.
Findings:
- A significant number of rheumatoid arthritis patients on gold therapy and some healthy controls also showed positive DLST responses to the gold compound.
- The DLST results indicate that a positive response to gold compounds is not exclusive to gold-induced pneumonitis.
Implications:
- The diagnostic utility of DLST for gold pneumonitis is questionable due to a high rate of false positives.
- Clinicians should exercise caution when interpreting positive DLST results for gold compounds in the context of suspected gold pneumonitis.
- Further research is needed to establish reliable diagnostic markers for gold-induced lung injury.