Follicular bronchiolitis in association with connective tissue diseases

Eleven patients with connective tissue diseases were found to have bronchiolar lesions associated with minimal or no alveolar septal thickening. Seven of these patients had rheumatoid arthritis, 3 had Sjögren's syndrome, and 1 had ankylosing spondylitis. Radiographic studies showed an interstitial pattern in all patients. The patients were nonsmokers and received no treatment prior to biopsy. All lung biopsy specimens showed inflammatory bronchiolar lesions which consisted of bronchiolar and peribronchiolar lymphocytic infiltrates (follicular bronchiolitis). The bronchiolar lesion has been reported previously in patients with connective tissue diseases treated with D-penicillamine; whether it represents a component of the systemic disease or a lack of effect of the therapeutic agent had not been established. The present study shows that several connective tissue diseases can be associated with inflammatory bronchiolar lesions.