jkra The Journal of the Korean Rheumatism Association J Korean Rheum Assoc 1226-8070 2233-4718 The Korean Rheumatism Association 10.4078/jkra.2009.16.4.312 jkra-16-312 Original Article Bronchiolitis Obliterans with Organizing Pneumonia (BOOP) in a Patient with Rheumatoid Arthritis YoonHo-Sung YounMoon-Hee ChinJung-Yeon LeeHwa-Jeong KwokSeung-Ki JuJi Hyeon ParkKyung-Su ParkSung-Hwan KimHo-Youn Division of Rheumatology, Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea 01 2009 20 01 2009 16 4 312 317 10082009 18082009 19082009 Copyright © 2009 The Korean Rheumatism Association 2009 This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. 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.

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

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

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).

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.