American College of Chest Physicians

T he occurrence of a reversible lupus-like syndrome in association with procaine amide therapy has been reported a number of times since the initial report by Ladd in 1962.1 Features distinguishing the syndrome from idiopathic systemic lupus erythematosus have been the lack of renal involvement and the disappearance of symptoms and serologic abnormalities upon withdrawal of the drug. Recently we have had the opportunity to see a patient who appears to have sustained permanent sequelae in the lungs and pleura in the form of a combined restrictive diffusion defect following a lupus-like syndrome secondary to procaine amide therapy. This occurred despite a course of corticosteroid therapy. The documentation of permanent disability following this type of drug reaction emphasizes the importance of recognizing the problem at an early stage.