No treatment is available and the course is progressively downhill resulting in death. Drug effects must be considered in the differential diagnosis of pulmonary infiltrates in these patients. Gold sodium thiomalate can cause a chronic interstitial pneumonitis, and sometime fibrosis. Penicillamine has also been related to changes in the lungs. The radiology can be considered under several categories, one or more being present at any one time.
Effusions are usually bilateral and small.
Atelectasis Areas of discoid atelectasis, usually in the lung bases, and often migratory, are commonly seen. They are frequently associated with pleuritis, effusion, and sometimes diaphragmatic dysfunction. Radiologically areas of consolidation are seen, usually in the lower lungs, simulating those of infection. The consolidation may become diffuse and extensive and lead to respiratory failure and death in spite of immunosuppressive therapy. The main differential diagnosis clinically and radiologically is that of infection.