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

Ho-Sung Yoon; Moon-Hee Youn; Jung-Yeon Chin; Hwa-Jeong Lee; Seung-Ki Kwok; Ji Hyeon Ju; Kyung-Su Park; Sung-Hwan Park; Ho-Youn Kim

doi:10.4078/jkra.2009.16.4.312

Journal List > J Korean Rheum Assoc > v.16(4) > 1003691

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Yoon, Youn, Chin, Lee, Kwok, Ju, Park, Park, and Kim: Bronchiolitis Obliterans with Organizing Pneumonia (BOOP) in a Patient with Rheumatoid Arthritis

Original Article

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

Published online: 20 January 2009

DOI: https://doi.org/10.4078/jkra.2009.16.4.312

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

Ho-Sung Yoon, Moon-Hee Youn, Jung-Yeon Chin, Hwa-Jeong Lee, Seung-Ki Kwok, Ji Hyeon Ju, Kyung-Su Park, Sung-Hwan Park, Ho-Youn Kim

Division of Rheumatology, Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea

Received 10 August 2009 Revised 18 August 2009 Accepted 19 August 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.

Keywords: Bronchiolitis obliterans organizing pneumonia (BOOP), Rheumatoid arthritis (RA)

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Fig. 1.

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

Fig. 2.

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

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).

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.

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