Fungus colonisation of pulmonary rheumatoid nodule.
This report describes a 69 year old woman, suffering from active rheumatoid arthritis since the age of 60 and presenting with severe dyspnoea and cough. A computed tomography scan of the chest showed multiple bilateral pulmonary nodules, sometimes cavitated, associated with reticular opacities and pleural effusion. A videothoracoscopic excision of a cavitated nodule was performed. Seven days after surgery, a right pneumothorax developed, and the patient died of septicaemia one month later. Microscopically, the excised nodule was composed of necrotic fibrinoid material with a peripheral rim of palisaded histiocytes, extending to the pleural surface and containing several fungal hyphae morphologically consistent with aspergillus. A diagnosis of pulmonary rheumatoid nodule with fungus colonisation was made. In the lung, fungus colonisation is a rare complication of rheumatoid nodules. The most important differential diagnostic considerations are briefly discussed.
Cavazza
A
A
Paci
M
M
Turrini
E
E
Dallari
R
R
Rossi
G
G
D000368:Aged; D001228:Aspergillosis / Q000175:diagnosis*; D001230:Aspergillus; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D025301:Hyphae; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008172:Lung Diseases, Fungal / Q000175:diagnosis*; D008727:Methotrexate / Q000627:therapeutic use; D012218:Rheumatoid Nodule / Q000382:microbiology*; D014057:Tomography, X-Ray Computed
D005938:Glucocorticoids; D007166:Immunosuppressive Agents; D008727:Methotrexate