Am. J. Respir. Crit. Care Med., Vol 155, No. 3, 03 1997, 1011-1020.
Gold-induced pulmonary disease: clinical features, outcome, and differentiation from rheumatoid lung disease
R Tomioka and TE King Jr
Department of Medicine, National Jewish Center for Immunology and Respiratory Medicine, University of Colorado Health Science Center, Denver 80206, USA.
Gold-induced pulmonary disease is difficult to diagnose, especially, in the
case in which interstitial pneumonia appears in the course of gold therapy
for rheumatoid arthritis. We analyzed the literature to define the clinical
features and prognosis of gold-induced pulmonary disease, and to identify
those features that distinguish gold-induced pulmonary disease from
pulmonary disease secondary to the underlying disease process of rheumatoid
arthritis. Relevant articles from the medical literature were identified
using a Mediline search, and the bibliographies of the articles were
retrieved. These works were critically reviewed for information on the
clinical, physiologic, radiographic, pathologic, and bronchoalveolar lavage
(BAL) findings. A total of 140 cases of gold-induced pulmonary disease were
identified from 110 reports. In 81% of the patients, gold was being used to
treat rheumatoid arthritis, bronchial asthma (6%), pemphigus (5%), or other
processes (9%). Side effects other than pulmonary toxicity were common, and
included skin rash (38%), peripheral eosinophilia (38%), liver dysfunction
(15%), and proteinuria (22%). Only the presence of pemphigus or liver
dysfunction correlated with a bad prognosis. Gold- induced pulmonary
disease most often followed improvement in rheumatoid arthritis, presumably
induced by gold therapy. BAL lymphocytosis and computed tomography (CT)
scan findings are useful in making a diagnosis of gold-induced pulmonary
disease in an appropriate clinical setting. Features that distinguish
gold-induced pulmonary disease from rheumatoid lung disease include female
predominance, presence of fever or skin rash, absence of subcutaneous
nodules or finger clubbing, low titers of rheumatoid factor at onset of
lung disease, lymphocytosis in bronchoalveolar lavage fluid (BALF), and
alveolar opacities along the bronchovascular bundles on chest CT scan.
Gold-induced lung disease is a distinct entity that can be distinguished
from rheumatoid lung disease. It usually improves with cessation of therapy
or treatment with corticosteriods.
