Diffuse Interstitial Pulmonary Fibrosis in Patients with a Positive Sheep Cell Agglutination Test.

In 1944 Hamman and Rich described an acute form of diffuse interstitial pulmonary fibrosis in four patients who died within six months of the onset of symptoms. Many cases with a similar syndrome have since been reported. The majority of these, however, have run a more chronic course and the outcome has not always been fatal. The disorder has been fully reviewed by Rubin and Lubliner (1957) and Scadding (1960); its aetiology remains unknown. A number of patients with rheumatoid disease have had diffuse pulmonary fibrosis indistinguishable from the idiopathic These patients have all had overt arthritis, except for one of the patients described by Ognibene (1960); in this instance there was diffuse pulmonary fibrosis and the sheep cell agglutination test (S.C.A.T.) was positive but there was no gross arthritis, a diagnosis of anarthritic rheumatoid disease (Bagratuni, 1956) being made. We report here two further similar cases. CASE REPORTS CASE 1 A woman aged 45 was admitted in May 1960. For seven years she had suffered from increasingly severe breathlessness on exertion and for five years she had had a dry cough which recently had become productive of white, mucoid sputum. This illness was accompanied by general tiredness and lassitude. During the two years before her admission she had been receiving digitalis and occasional chlorothiazide from her general practitioner for the treatment of ankle swelling; the swelling improved but there was no change in the increasing breathlessness.