Bronchiolitis obliterans and rheumatoid arthritis. Report of a case in a Chinese patient on d-penicillamine and review of the literature

Ann Acad Med Singap. 1993 May;22(3):365-8.


Rheumatoid arthritis is the commonest connective tissue disease associated with bronchiolitis obliterans, a clinico-pathologic entity of bronchiolar inflammation and fibrosis reflecting injury to the small airways, and presenting with symptoms and signs of small airways obstruction. It may arise de novo or as a complication of therapy due to d-penicillamine, when a distinct histologic picture of bronchiolar constriction without intraluminal inflammatory polyps appeared to be predominant in most reported cases. This condition is associated with a high morbidity and mortality, and apart from cessation of d-penicillamine, there are no standard recommendations for treatment. Response to various immunosuppressive agents, including corticosteroid, azathioprine, and cyclophosphamide, had been variable and unsatisfactory. We report a case of bronchiolitis obliterans in a Chinese female treated with d-Penicillamine for rheumatoid arthritis with the first documented response to corticosteroid alone, and review the literature on this subject.

Publication types

  • Case Reports
  • Review

MeSH terms

  • Adult
  • Arthritis, Rheumatoid / complications*
  • Arthritis, Rheumatoid / drug therapy
  • Arthritis, Rheumatoid / ethnology
  • Biopsy
  • Bronchiolitis Obliterans / chemically induced*
  • Bronchiolitis Obliterans / diagnosis
  • Bronchiolitis Obliterans / ethnology
  • Bronchoscopy
  • China / ethnology
  • Female
  • Hong Kong
  • Humans
  • Lung / pathology
  • Penicillamine / adverse effects*


  • Penicillamine