Bronchiolitis and bronchitis in connective tissue disease. A possible relationship to the use of penicillamine

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Abstract
Rapid onset of severe and irreversible airflow obstruction developed in 2 women. One had eosinophilic fasciitis and the other had rheumatoid arthritis. Both were treated with penicillamine. In the 1st patient, aged 42 yr, dyspnea developed after 6 mo. of therapy. Her roentoenogram showed hyperinflation. Forced vital capacity [FVC] expired in 1 s (FEV1[forced expiratory volume in 1 s]/FVC%) decreased from 75% to 40%, and the residual volume increased by 1 l. In the 2nd patient, aged 54 yr, cough and dyspnea developed after 10 mo. of therapy. The FEV1/FVC% was 56%, the FEV1 was 0.9 l, and the roentgenogram was normal. Lung biopsy specimens demonstrated severe and widespread bronchiolitis. An association between obliterative bronchiolitis and rheumatoid arthritis was reported. Penicillamine may impair healing of bronchiolitis in such patients.