Rheumatoid arthritis with diffuse pulmonary rheumatoid nodules.
Rheumatoid nodules in dermal or subcutaneous tissues, while indicative of rheumatoid arthritis, are very rare. It is even less common to identify these rheumatoid nodules by biopsy as well as in autopsy materials from lung tissue. These nodules may be single or multiple, which seldom cause respiratory symptoms. Here, a patient with diffuse pulmonary rheumatoid nodules and interstitial fibrosis throughout both lungs, is described. The patient, with articular symptoms and seropositivity, exhibited a rapid clinical course and died of respiratory failure 3 months after the appearance of dyspnea. Chest radiography indicated interstitial pneumonitis with bilateral diffuse peripheral shadows. At autopsy, numerous rheumatoid nodules and interstitial fibrosis had destroyed both lungs, such that no residual normal pulmonary tissue remained. It is believed that this was an extremely rare case exhibiting large numbers of rheumatoid nodules throughout the lungs. Findings with this patient indicate that, in patients with rheumatoid arthritis, clinical interstitial pneumonitis confirmed radiologically does not exclude the existence of rheumatoid lung nodules.
Department of Pathology of Biological Response, Nagoya University Graduate School of Medicine, Nagoya, Japan. atsukok@med.nagoya-u.ac.jp
Atsuko
A
Kitamura
Tadakatsu
T
Matsuno
Michihiko
M
Narita
Kaoru
K
Shimokata
Yoriko
Y
Yamashita
Naoyoshi
N
Mori
D001172:Arthritis, Rheumatoid / Q000150:complications / Q000473:pathology*; D017809:Fatal Outcome; D006801:Humans; D008168:Lung / Q000473:pathology*; D008171:Lung Diseases / Q000209:etiology / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D013902:Radiography, Thoracic; D012131:Respiratory Insufficiency / Q000209:etiology / Q000473:pathology; D012218:Rheumatoid Nodule / Q000150:complications / Q000473:pathology*; D014057:Tomography, X-Ray Computed