Three patients with rheumatoid arthritis developed acute respiratory distress associated with pulmonary infiltration, during treatment with sodium aurothiomalate. This manifestation of gold toxicity has only recently been recognized. The temporal relationship to the introduction of gold therapy, an exacerbation following further gold injection in one patient, the resolution which followed gold withdrawal and the associated manifestation of gold toxicity in two patients favored a diagnosis of gold-induced pulmonary disease.