Penicillamine pneumonitis

T e III reactions are mimicked by nitrofurantoin (pneumonitis) and penicillamine (nephropathy). Lupus erythematosus due to drugs (procainamide, isoniazid, phenytoin) may be pseudoallergic. 

Some drugs such as hydralazine or procainamide may induce lupus like diseases with antinuclear antibodies and proteinuria. D-penicillamine not only causes glomerulopathies, but also myasthenia, polymyositis or lupus, suggesting that this compound provokes immune disregulation. Gold salts also are capable of inducing various immunopathological disorders such as pneumonitis, anemia, thrombocytopenia and hepatitis. 

Respiratory Hypersensitivity pneumonitis has been attributed to penicillamine [47 ]. 

D-Penicillamine is used in the treatment of rheumatoid arthritis. Several types of pulmonary toxicities have been described with this agent. A pulmonary-renal syndrome similar to Goodpasture s syndrome has been rarely described and is fatal in 50% of the cases. Hemoptysis and hematuria are present in an acute fashion and warrant prompt discontinuation of the drug. Anti-glomerular basement membrane antibodies are not found and the role of plasmapheresis in undetermined. Treatment with corticosteroids or immunosuppressive agents may be of benefit (21). Bronchiolitis obliterans with or without organizing pneumonia has also been reported, but is also described with rheumatoid arthritis. Hypersensitivity pneumonitis and the subacute onset of pulmonary fibrosis have been... 

Walker T, McCaffery J, Steinfort C. Potential link between HMG-CoA reductase inhibitor (statin) use and interstitial lung disease. Med J Aust 2007 186 91-94. Camus P, Reybet Degat O, Justrabo E, et al. D-penicillamine induced severe pneumonitis. Chest 1982 81 376-378. 

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