Symptoms begin weeks-months after starting gold therapy
More commonly associated with sodium aurothiomalate than with aurothioglucose (although this may be related to the frequency of use of these agents)
Diagnosis
CBC: periperhal eosinophilia is uncommon
CXR/Chest CT: interstitial infiltrates (upper lobe-predominance) with absence of pleural effusions
FOB-BAL: lymphocytosis
OLB: fibrosis with interstitial infiltrate of lymphocytes and plasma cells, focal hyperplasia of type II pneumocytes
EM: electron-dense structures within lysosomes of endothelal cells of alveolar capillaries and interstitial macrophages -> demonstrated to be gold inside these (unclear role, since there are no control studies with lung biopsies from patients on gold therapy without lung disease)
Clinical: insidious onset of dyspnea with or without fever
Treatment: withdraw drug with or without corticosteroids
Response to drug withdrawal and/or corticostroids suggests that gold was etiologic, rather than the underlying RA
Prognosis
No deaths reported from gold-related pulmonary fibrosis
