Late appearing nitritoid reactions
To The Editor:
Podell et a1 in their article "Pulmonary Toxicity with Gold Therapy" (Arthritis Rheum 23:347-350, 1980) note that nitritoid reactions to the thiomalate preparation are common and occur early in the course of treatment. I should like to report a somewhat different experience. All my patients are begun on the thiomalate preparation, and in only three has a nitritoid response appeared. In one case, it occurred at 1,000 mg. But in 2 instances the reaction was very late, as the following descriptions indicate.
CS, a 75-year-old woman, began gold injections 9 years ago. After 8 years and having received 6,225 mg of gold sodium thiomalate, she had a typical nitritoid reaction. She was switched to the thioglucose preparation and has had no further problem. An electrocardiogram (ECG) revealed no acute changes.
BB, a 76-year-old woman, began treatment 14 years ago. There was an excellent response for several years, followed by a gradual relapse. After 9 years, gold injections were discontinued after a total of 7,600 mg, and various other modalities were tried without success. After a year, gold sodium thiomalate was resumed which resulted in considerable improvement. After 2% years and a total of 3,300 mg, a typical nitritoid reaction occurred. With the thioglucose preparation, there has been no problem. An ECG revealed no acute changes.
The above reports are intended to alert the physician employing gold salt injections to be aware of very late appearing nitritoid reactions with the gold sodium t hiomalate .