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 family history of deforming rheumatoid arthritis, and a serum rheumatoid factor of 1:1,256, but with no evidence of active rheumatological disease. Clinical, physiological and radiologic features suggested bronchiolitis obliterans, and this was confirmed by open lung biopsy. Immune staining of tissue revealed immunoglobulin M (IgM) as well as rare immunoglobulin (IgG) containing plasma cells in a peribronchiolar location. Because of these findings, we suggest that this case represents bronchiolitis 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 that the bronchiolitis obliterans of rheumatoid arthritis occurs primarily in women and only in ongoing cases.