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- Title
Rheumatoid arthritis with necrotic lung nodules.
- Authors
Sharma, Ashish; Pandey, Bimlesh Dhar; Gupta, Rajesh; Chaturvedi, Arti
- Abstract
Rheumatoid arthritis is a multisystemic inflammatory disease. Lungs are the commonest site of extra-articular involvement. Rheumatoid lung nodules occur infrequently and can undergo necrosis giving rise to necrobiotic lung nodules. Infections, malignancy and granulomatosis with polyangiitis are more common causes of cavitating lung nodules. Presence of rheumatoid factor, history of smoking and use of methotrexate increase the chances of developing rheumatoid lung nodulosis. Histopathological examination of the nodule is essential to make a correct diagnosis. We present a 74-year-old male with long-standing rheumatoid arthritis who had multiple cavitating lung nodules. Biopsy from the lung nodule could not be performed as the patient refused to consent. However, infection, malignancy and granulomatosis with polyangiitis were ruled out on the basis of blood investigations and bronchoscopy. He was empirically treated with a moderate dose of glucocorticoid along with conventional synthetic disease-modifying antirheumatic drugs. After three months of treatment, the lung nodules disappeared completely and his articular symptoms showed marked improvement.
- Subjects
PULMONARY nodules; RHEUMATOID arthritis; METHOTREXATE; GLUCOCORTICOIDS; STEROID drugs; LUNG biopsy
- Publication
Journal of the Royal College of Physicians of Edinburgh, 2020, Vol 50, Issue 3, p307
- ISSN
1478-2715
- Publication type
Case Study
- DOI
10.4997/JRCPE.2020.321