[Respiratory complications in the course of treatment with D-penicillamine : alveolitis and bronchiolitis. A report of 4 cases (author's transl)].

D-penicillamine has proved to be an effective treatment of rheumatoid arthritis, but adverse effects of this drug are frequent. The authors report 4 cases of respiratory disease in the course of treatments with D-penicillamine for which the drug may probably be held responsible. Two patients presented with diffuse alveolitis which improved on stopping D-penicillamine. Two patients presented with rapidly progressive dyspnea; chest X-ray showed distended lungs; lung function tests showed severe airflow obstruction with air trapping : treatment with bronchodilators and corticosteroids was ineffective. Several cases of patients with such features have been reported during the last few years; pathologic studies which were performed disclosed bronchiolitis. Clinicians should be aware of the severity of this type of bronchiolitis and stop D-penicillamine immediately in patients presenting with early respiratory symptoms.