IPPB, SMI, gloves: good or bad?

COMMUNICATIONSTO THE EDITOR 615 misdiagnosed as diffuse alveolar damage or fibrosing alveolitis. Dr. Carrington has re-reviewed the slides and agrees that this is an example of eosinophilic pneumonia with an unusual degree of bronchiolitis obliterans. The patient has also been included in another report4 as an example of acute fibrosing alveolitis. It is recognized that patients with rheumatoid arthritis and eosinophilia are more likely to have systemic complications of rheumatoid disease, including lung complications. The levels of eosinophils in the blood are not recorded in the report by Geddes et al6 of rheumatoid bronchiolitis, but two patients had pulmonary infiltrates and in one this was transient. No coherent hypothesis can be presented, but it appears that there is an overlap between rheumatoid disease, eosinophilic pneumonia and bronchiolitis obliterans. It also appears that while the lung infiltrate of eosinophilic pneumonia is rapidly reversible, the airway lesions are not. The development of chronic airflow limitation and the disappearance of lung infiltrates is not a common feature of fibrosing alveolitis and this occurrence should suggest an unusual condition.