Occasionally a patient with rheumatoid arthritis who is being treated with a gold compound (chrysotherapy) will develop a hypersensitivity pneumonitis. Evans et al listed clinical findings associated with the syndrome. The authors are from Brown University and two community hospitals in Rhode Island.



(1) The patient has a history of rheumatoid arthritis treated with gold compounds.

(2) The patient experiences the acute or subacute onset of pulmonary signs and symptoms (dry, nonproductive cough; tachypnea; coarse crackles over the lung fields; hypoxemia).

(3) The chest X-ray shows a diffuse interstitial and/or alveolar filling pattern.

(4) The broncho-alveolar lavage (BAL) shows a lymphocytosis with a helper to suppressor (CD4 to CD8) ratio < 1 (normally 1.4 to 2.0).

(5) The patient shows clinical improvement on discontinuation of gold compounds and with corticosteroid therapy.

(6) Respiratory symptoms recur quickly after re-exposure to gold compounds.


Differential diagnosis:

(1) pulmonary involvement by rheumatoid arthritis

(2) pneumonia


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