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Bucillamine induced pulmonary injury occurs with immunoglobulin decrease

S Inokuma1, M Sakata, A Yoshida

  • 1Department of Allergy and Immunological Diseases, Tokyo Metropolitan Komagome Hospital, Japan.

The Journal of Rheumatology
|July 1, 1996
PubMed
Summary
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Bucillamine treatment for rheumatoid arthritis can cause lung injury, characterized by specific lung infiltrates and decreased immunoglobulin levels. Discontinuing the drug resolved lung issues without worsening arthritis.

Area of Science:

  • Rheumatology
  • Pulmonology
  • Pharmacology

Background:

  • Rheumatoid arthritis (RA) is a chronic autoimmune disease.
  • Bucillamine is a disease-modifying antirheumatic drug (DMARD) used to treat RA.
  • Pulmonary complications can occur in patients with RA.

Observation:

  • Three RA patients treated with bucillamine developed pulmonary involvement despite remission of synovitis.
  • Radiological findings included bilateral central lung infiltrates with air bronchograms, sparing the lung periphery.
  • Lung biopsies showed organizing exudates and cellular infiltration in the alveoli and septa.

Findings:

  • Serum immunoglobulin (Ig) levels were markedly decreased during pulmonary involvement.
  • Discontinuation of bucillamine led to resolution of lung injury.

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  • Arthritis symptoms did not worsen after bucillamine cessation, and Ig levels increased.

    • Implications:

    • Bucillamine may cause drug-induced lung injury in RA patients.
    • Monitoring Ig levels could be important in patients on bucillamine.
    • Pulmonary involvement may be linked to decreased Ig concentrations, suggesting a potential therapeutic mechanism.