Bronchiolitis obliterans organizing pneumonia in polymyositis. A case report with longterm survival

In 1973, a 36-year-old black woman with dyspnea on exertion, Raynaud's phenomenon and arthralgia was first seen at the University of California at Los Angeles Medical Center. Her chest roentgenography showed bilateral basilar infiltration, open lung biopsy revealed bronchiolitis obliterans with organizing pneumonia (BOOP) and muscle biopsy was consistent with inflammatory myopathy. She has been followed for 18 years, has responded well to conservative treatment, initially with alternate day prednisone, with added azathioprine for the past 8 years, and remained fully employed. The favorable prognosis of this case is consistent with that of the BOOP category proposed by Tazelaar, et al in 1990. We conclude that a careful histological subclassification is suggested before initiating aggressive therapy in patients with polymyositis and interstitial lung disease.