Wolfe F, Schurle D R, Lin J J, Polland S M, Smith T W, Montgomery-Short R, James D L
J Rheumatol. 1983 Jun;10(3):406-10.
Four of 133 patients with rheumatoid arthritis suddenly developed progressive respiratory symptoms while receiving penicillamine therapy. None had previous disease. None of 89 patients treated with gold alone and 0 of 380 not taking gold or penicillamine developed respiratory symptoms. Two of the 4 developed simultaneous severe, unresponsive sinusitis. Lung biopsy demonstrated obliterative bronchiolitis (OB) in 2 patients, fibrosing alveolitis in one. A clinical course characteristic of OB was noted in the 4th patient. Sinus biopsy in 2 demonstrated lymphocytic and plasmacytic mucosal infiltration. The high frequency of OB in penicillamine treated patients and its absence in 469 non penicillamine treated patients suggests the possibility of a causal relationship.
133例类风湿性关节炎患者中有4例在接受青霉胺治疗时突然出现进行性呼吸道症状。此前均无相关疾病。单独接受金制剂治疗的89例患者中无一例出现呼吸道症状，380例未接受金制剂或青霉胺治疗的患者中也无0例出现呼吸道症状。4例患者中有2例同时出现严重的、对抗治疗无效的鼻窦炎。肺活检显示2例患者有闭塞性细支气管炎（OB），1例有纤维化肺泡炎。第4例患者具有OB的典型临床病程。2例患者的鼻窦活检显示淋巴细胞和浆细胞黏膜浸润。青霉胺治疗患者中OB的高发生率以及469例未接受青霉胺治疗患者中未出现OB提示存在因果关系的可能性。
