Pleural effusion during bromocriptine exposure in two patients with pre-existing asbestos pleural plaques: a relationship?

Our plain-English summary of Pleural effusion during bromocriptine exposure in two patients with pre-existing asbestos pleural plaques: a relationship?, by C. Knoop, M. Mairesse, C. Lenclud, et al (The European Respiratory Journal, 1997).

The study

• Authors: C. Knoop, M. Mairesse, C. Lenclud, P.A. Gevenois, P. De Vuyst
• Journal: The European Respiratory Journal
• Published: 1997;10(12):2898-901
• Type of article: Case report
• Cited by: 8 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Two patients with pleural plaques developed pleural effusion and subsequent diffuse pleural fibrosis 50 and 39 yrs after their first exposure to asbestos. The diagnosis of benign asbestos pleural effusion was suggested, but the work-up finally suggested bromocriptine-induced pleural disease in both patients. These two cases illustrate that drug-induced pleural effusion is an important differential diagnosis of benign asbestos pleural effusion. It is, moreover, possible that pre-existing asbestos pleural lesions, or even asbestos exposure, increases the risk of developing bromocriptine-induced pleural disease.

In plain English

This case report from Belgium described two men with earlier asbestos-related changes in the lining of the lungs who developed fluid around the lungs (pleural effusion) while taking bromocriptine for Parkinson's disease. The first, a 64-year-old who had worked in a railway factory with asbestos insulation, was admitted in December 1994 with a large right-sided effusion and diffuse pleural fibrosis. The second, a 58-year-old tiler-plasterer exposed to asbestos between 1950 and 1965, was admitted in June 1989 with a right-sided effusion. In both men, benign asbestos pleural effusion was first suggested, but the work-up pointed to bromocriptine. After the drug was stopped, the first man, who also received steroids, had normal lung function 12 months after he first presented. The second man's general symptoms eased quickly, but his chest X-ray and lung function did not improve substantially. The authors concluded that drug-induced effusion should be considered in asbestos-exposed workers. They said they could not prove it, but they felt that asbestos-exposed patients may be at increased risk of pleural effusions of any kind.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: case report of two patients
• Who was studied: Two men in Belgium (Erasme Hospital, Brussels, and Clinique Saint-Luc, Bouge). One was 64 years old and admitted in December 1994. The other was 58 years old and admitted in June 1989. Both had pre-existing asbestos pleural lesions and Parkinson's disease treated with bromocriptine.
• Exposure: Patient 1 worked in a railway factory from 1946 to 1956 and from 1969 to 1984. He was exposed to asbestos used as an insulation material, particularly intensely between 1946 and 1954. Patient 2 worked as a tiler-plasterer and was exposed to asbestos fibres between 1950 and 1965. No fiber type was named. Both men also took bromocriptine: patient 1 from September 1993, and patient 2 from 1986.
• Main results:
  • Patient 1: CT scanning after the fluid was drained confirmed diffuse pleural fibrosis with rounded atelectasis.
  • Patient 1: the pleural fluid was a sterile lymphocytic exudate, and no malignant cells were found.
  • Patient 1: his cumulative bromocriptine dose when the drug was stopped was 13.5 g.
  • Patient 1: after bromocriptine was tailed off and prednisolone was given, his lung function was normal 12 months after initial presentation. His chest radiograph still showed pleural thickening.
  • Patient 1: the authors judged that bromocriptine was the cause. They based this on the timing (15 months after starting the drug), the acute systemic illness, and prompt resolution after the drug was stopped.
  • Patient 2: the pleural fluid was a sterile eosinophilic exudate (60%).
  • Patient 2: his bronchoalveolar lavage contained 5 asbestos bodies per mL (normal value under 1 per mL).
  • Patient 2: bromocriptine was stopped in December 1990 at a cumulative dose of 26.4 g. His general symptoms abated quickly, and the inflammatory syndrome disappeared within a month.
  • Patient 2: neither his chest radiograph nor his lung function improved substantially.
• The authors' conclusion: The authors concluded that drug-induced effusion should be considered in asbestos-exposed workers, alongside benign asbestos pleural effusion. They also felt that the combination in these patients was not chance, and that patients exposed to asbestos may be at increased risk of pleural effusions of any kind.
• Limitations the authors state:
  • The authors stated that they cannot prove the link between asbestos and bromocriptine-induced pleural disease in these patients.
  • The authors noted that, apart from pleural calcifications, ergot-induced pleural lesions cannot be told apart from asbestos-induced ones. This makes the diagnosis uncertain.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Asbestosis, Pleural plaques and thickening.

Medical terms in this study, explained in our Lexicon: Pleural Effusion, Pleural Plaques, Fibrosis, Benign Asbestos Pleural Effusion, Differential Diagnosis, Asbestos Exposure.

Related studies

• Pleural disease during treatment with bromocriptine in patients previously exposed to asbestos — G. Hillerdal, J. Lee, et al. (1997)
• Rounded atelectasis and respiratory compromise secondary to pergolide use — C.I. Bloom, G.E. Wilson (2009)
• Pleuropulmonary fibrosis after long-term treatment with the dopamine agonist pergolide for Parkinson Disease — R. Tintner, P. Manian, et al. (2005)
• Asbestos, ergot drugs and the pleura — P. Camus, G. Hillerdal, et al. (1998)
• Asbestos pleural effusion — E.A. Gaensler, A.I. Kaplan (1971)
• Deletion status of p16 in effusion smear preparation correlates with that of underlying malignant pleural mesothelioma tissue — T. Hida, S. Matsumoto, et al. (2015)

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