Gold

History

  • Gold has been used since ancient times to treat disease

Indications


Agents

  • Aurothiopropanosulfonate
  • Aurothiomalate
  • Aurothioglucose

Pharmacology

  • xxx

Adverse Effects

Pulmonary Adverse Effects

  • Interstitial Pulmonary Fibrosis (see Interstitial Lung Disease-Etiology, [[Interstitial Lung Disease-Etiology]])
    • Epidemiology
      • Symptoms begin weeks-months after starting gold therapy
      • More commonly associated with sodium aurothiomalate than with aurothioglucose (although this may be related to the frequency of use of these agents)
    • Diagnosis
      • CBC: periperhal eosinophilia is uncommon
      • CXR/Chest CT: interstitial infiltrates (upper lobe-predominance) with absence of pleural effusions
      • FOB-BAL: lymphocytosis
      • OLB: fibrosis with interstitial infiltrate of lymphocytes and plasma cells, focal hyperplasia of type II pneumocytes
        • EM: electron-dense structures within lysosomes of endothelal cells of alveolar capillaries and interstitial macrophages -> demonstrated to be gold inside these (unclear role, since there are no control studies with lung biopsies from patients on gold therapy without lung disease)
    • Clinical: insidious onset of dyspnea with or without fever
    • Treatment: withdraw drug with or without corticosteroids
      • Response to drug withdrawal and/or corticostroids suggests that gold was etiologic, rather than the underlying RA
    • Prognosis
      • No deaths reported from gold-related pulmonary fibrosis
      • No increased risk of infection with gold therapy
  • Hypersensitivity Pneumonitis (see Hypersensitivity Pneumonitis, [[Hypersensitivity Pneumonitis]])
  • Drug-Induced Pulmonary Eosinophilia (see Drug-Induced Pulmonary Eosinophilia, [[Drug-Induced Pulmonary Eosinophilia]])
  • Bronchiolitis Obliterans (see Bronchiolitis Obliterans, [[Bronchiolitis Obliterans]])
  • Cryptogenic Organizing Pneumonia (see Cryptogenic Organizing Pneumonia, [[Cryptogenic Organizing Pneumonia]] and Lung Nodule or Mass, [[Lung Nodule or Mass]])
    • May appear as nodular infiltrates

Other Adverse Effects

  • Dermatitis
  • Peripheral Neuropathy
  • Nephrotic Syndrome with Proteinuria

References

  • xxxx