Progressive interstitial lung disease in a 75 year old woman

The case of a 75 year old woman with rapidly progressive interstitial lung disease is presented. Bronchoalveolar lavage (BAL) was consistent with CD8+ cell alveolitis, and computerized tomography revealed features of bronchiolitis obliterans organizing pneumonia (BOOP). The patient had been on clomipramine (a tricyclic antidepressant) for 9 months prior to the onset of disease. Cessation of the drug and very short-term oral corticosteroid treatment (prematurely terminated by the patient) resulted in complete resolution of clinical symptoms, morphological and physiological findings, which remained stable without treatment over the following year. A possible drug reaction to clomipramine presenting as BOOP is discussed.