J Korean Rheum Assoc.  2009 Dec;16(4):312-317.

Bronchiolitis Obliterans with Organizing Pneumonia (BOOP) in a Patient with Rheumatoid Arthritis

• Yoon HS
• Youn MH
• Chin JY
• Lee HJ
• Kwok SK
• Ju JH
• Park KS
• Park SH
• Kim HY

Abstract

Interstitial lung disease (ILD) is one of the common extra-articular manifestations of rheumatoid arthritis (RA). Bronchiolitis obliterans with organizing pneumonia (BOOP) is one type of ILD, and this is characterized by the proliferation of granulation tissue in the bronchioles, alveolar ducts and some alveoli and interstitial infiltration by chronic inflammatory cells. It develops as a manifestation of RA or as a side effect of anti-rheumatic drugs in patients with RA. We experienced a 41-year-old female patient with RA who developed BOOP during the treatment with methotrexate and bucillamine. She presented with cough and sputum for several months and pleuritic chest pain for one week. The chest radiograph showed bilateral multifocal consolidations. She received thoracoscopic biopsy and her pulmonary infiltrations resolved after the treatment with corticosteroid.

Keyword

Bronchiolitis obliterans organizing pneumonia (BOOP); Rheumatoid arthritis (RA)

MeSH Terms

Adult
Antirheumatic Agents
Arthritis, Rheumatoid
Biopsy
Bronchioles
Bronchiolitis
Bronchiolitis Obliterans
Chest Pain
Cough
Cryptogenic Organizing Pneumonia
Cysteine
Female
Granulation Tissue
Humans
Lung Diseases, Interstitial
Methotrexate
Pneumonia
Sputum
Thorax
Antirheumatic Agents
Cysteine
Methotrexate

Figure

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  Fig. 1. The chest PA shows bilateral multiple consolidations with ill-defined margins.

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  Fig. 2. The chest HRCT shows multiple peripheral macronodules and patchy consolidation in both the mid-lung and lower lung field.

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  Fig. 3. The video-assisted thoracoscopic wedge resection specimen (H&E stain) shows interstitial inflammatory cell infiltration and granulation tissue occupying the bronchioles and alveolar ducts (A, ×12.5) and myofibroblastic tissue filling the alveolar cavity (B, ×400).

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  Fig. 4. The chest PA taken one month after the beginning of corticosteroid treatment shows resolution of the bilateral multifocal consolidations. Post surgical scarring is also noted at the right costo-phrenic angle area.

Reference

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