Diffuse pulmonary injury associated with gold treatment.

A patient showing a gold-induced diffuse pulmonary reaction is described. An open lung biopsy specimen showed thickening of alveolar septa due to inflammation. The alveolar walls were lined by cuboidal epithelium. On electron microscope examination electron-dense structures were observed within lysosomes of endothelial cells of the alveolar capillaries and interstitial macrophages. Electron probe microanalysis showed that these structures contained gold. The accumulation of gold in endothelial cells and macrophages and a direct toxic effect might be an important feature in the pathogenesis of gold-induced pulmonary reactions. On the other hand the accumulation of gold may reflect exposure rather than disease.