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[3 cases of obliterating bronchiolitis during treatment of rheumatoid polyarthritis with D-penicillamine].

The authors report three cases of bronchiolitis obliterans occurring during treatment of rheumatoid arthritis with D-penicillamine after 4, 6 and 8 months of treatment and when the rheumatoid arthritis was in a state of remission. None of these patients (2 sero-positive and 1 sero-negative) present any past history of pulmonary or bronchial disease. The daily dosage of D-penicillamine never exceeded 600 mg. High dose corticosteroid therapy was unable to improve the clinical signs or the respiratory function tests, which were severely disturbed. After 15 months to 3 years, the respiratory signs deteriorated in 2 of the 3 patients. The onset of dyspnea and cough, in the absence of a seasonal infection, in a subject treated with D-penicillamine should raise the possibility of this very serious complication.