Rounded atelectasis and respiratory compromise secondary to pergolide use

Our plain-English summary of Rounded atelectasis and respiratory compromise secondary to pergolide use, by C.I. Bloom, G.E. Wilson (Respirology, 2009).

The study

• Authors: C.I. Bloom, G.E. Wilson
• Journal: Respirology
• Published: 2009;14(6):906-7
• Type of article: Case report
• Cited by: 2 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Rounded atelectasis is an unusual form of peripheral atelectasis that develops as a consequence of pleural disease. It is usually thought to be a benign process after malignancy and infection have been excluded. Pergolide is an ergot-derived dopamine agonist that has been associated with pleuropulmonary fibrosis and fibrotic cardiac valve disease. Pergolide-associated rounded atelectasis has occurred in patients with known asbestos exposure. We report a patient with no known asbestos exposure who developed rounded atelectasis and subsequent symptomatic diffuse restrictive pleural disease. Physicians should consider drugs early on in their work-up of rounded atelectasis as discontinuation of the agent may reverse the process.

In plain English

This was a case report about one patient. A 77-year-old Australian man who had never smoked had worsening breathlessness. A year earlier he had been diagnosed with rounded atelectasis, a folded area of lung linked to pleural disease. Tests then found no cancer cells, bacteria or asbestos bodies, and talc was used to seal the left pleural space. He had been taking pergolide, a Parkinson's disease drug, for 10 years and was on 2 mg a day when he presented; he had no known asbestos exposure. A CT scan showed rounded atelectasis in the right lung and thickening and scarring of the pleura on both sides, with more lung volume loss than a year before. Lung tests showed a restrictive pattern, with total lung capacity at 58% of predicted. A heart valve removed earlier showed changes consistent with pergolide exposure. After pergolide was slowly stopped and replaced with ropinirole, his symptoms initially improved, CRP (an inflammation marker) fell and he needed less oxygen. Further testing was pending. The authors concluded that doctors should consider drugs early when investigating pleural disease, as stopping them may bring improvement.

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 (single patient)
• Who was studied: One 77-year-old Australian man who had never smoked, with Parkinson's disease and a previous mitral valve replacement. The authors were based at Hillingdon Hospital and Charing Cross Hospital, London, UK. Dates of care were not given.
• Exposure: Pergolide (an ergot-derived dopamine agonist), used for 10 years. His current dose at presentation was 2 mg/day; the article does not say whether this dose was the same throughout. He was a retired food critic with no known asbestos exposure.
• Main results:
  • One year before this presentation, bronchial lavage fluid showed no malignant cells, asbestos bodies or bacteria.
  • CT at presentation showed rounded atelectasis in the right lung, bilateral pleural thickening and pleural fibrosis.
  • Compared with a CT one year earlier, there was progressive volume loss due to the pleural fibrosis.
  • Lung function in this patient: TLC 58% predicted and DLCO 57% predicted. The authors described this as a pattern in keeping with restrictive disease secondary to pleural pathology.
  • Review of the histology of the mitral valve, replaced three years earlier, suggested chronic myxoid fibrosis consistent with pergolide exposure.
  • After pergolide was tapered off and ropinirole introduced, the patient had an initial good symptomatic response, a fall in CRP and reduced oxygen requirements.
• The authors' conclusion: The authors concluded that this case highlights that physicians should consider drugs early in the work-up of pleural disease, as removal may result in clinical improvement.
• Limitations the authors state:
  • Follow-up was incomplete: further lung function and radiological assessment was still pending.
  • The authors noted there are no definitive tests for drug-related pleural disease. The diagnosis ultimately rests on the patient's response to stopping the drug.

Topics

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

Medical terms in this study, explained in our Lexicon: Rounded Atelectasis, Atelectasis, Fibrosis, Asbestos Exposure.

Related studies

• Pleuropulmonary fibrosis after long-term treatment with the dopamine agonist pergolide for Parkinson Disease — R. Tintner, P. Manian, et al. (2005)
• Rounded atelectasis. Clinical experience with 74 patients — G. Hillerdal (1989)
• Rounded atelectasis and its association with asbestos-induced pleural disease — R.A. Mintzer, R.M. Gore, et al. (1981)
• The association of asbestos-induced pleural disease and rounded atelectasis — R.A. Mintzer, D.W. Cugell (1982)
• Rounded atelectasis of the lung — G.T. Stathopoulos, M.T. Karamessini, et al. (2005)
• Asbestos-related rounded atelectasis. Radiologic and mineralogic data in 23 cases — C. Voisin, F. Fisekci, et al. (1995)

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