What to Do with All of These Lung Nodules?

Caplan syndrome is a rare entity that is specific to rheumatoid arthritis and presents with multiple, well-defined necrotic nodules in patients with occupational dust exposure. The present report describes a case of Caplan syndrome involving a 71-year-old man with a known diagnosis of seropositive rheumatoid arthritis who presented to the authors’ centre with a five-year history of multiple, bilateral cavitary lung nodules with mild dyspnea on exertion. He was an ex-smoker (30 pack-years) and had previously worked with silica. The case highlights the clinical, radiological and pathological features of this syndrome and outlines the importance of considering a broad differential in the management of pulmonary nodules, especially in patients with rheumatoid arthritis.

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Active rheumatoid arthritis with multiple pulmonary nodules failure to multiple remissive therapy: Which is the solution?

Romanian Journal of Rheumatology ◽

10.37897/rjr.2021.3.7 ◽

2021 ◽

Vol 30 (3) ◽

pp. 125-128

Author(s):

Ileana Cosmina Filipescu ◽

◽

Milena Man ◽

Simona Rednic ◽

◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Active Rheumatoid Arthritis ◽

Pulmonary Nodules ◽

Lung Nodules ◽

Imaging Studies ◽

Disease Modifying Antirheumatic Drugs ◽

Antirheumatic Drugs ◽

History Of ◽

Disease Modifying ◽

Anti Fungal

We describe the case of a 63-year-old nonsmoker woman, with a long history of active seropositive rheumatoid arthritis, failure to multiple disease-modifying antirheumatic drugs due to both loss of efficacy and adverse drug reaction. She was exposed to silicon dust some years ago and has many pulmonary nodules, revealed by imaging studies as multiple cavitary lung nodules. Her initial pathological samples were negative for any infections and treatment against tuberculosis and anti-fungal therapy did not improve the appearance of the nodules. After an extensive reevaluation of pulmonary nodules, the Baricitinib treatment was started.

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Pulmonary Crohn's Disease in Down Syndrome: A Link or Linkage Problem

Case Reports in Gastroenterology ◽

10.1159/000445975 ◽

2016 ◽

Vol 10 (2) ◽

pp. 206-211

Author(s):

Danyal Thaver ◽

Mirza Beg

Keyword(s):

Down Syndrome ◽

Crohn’S Disease ◽

Crohn's Disease ◽

Pediatric Population ◽

Pulmonary Nodules ◽

Pulmonary Involvement ◽

Lung Nodules ◽

Inflammatory Disorder ◽

Ct Guided ◽

History Of

Crohn’s disease (CD) is an autoimmune inflammatory disorder that primarily affects the gastrointestinal tract. It may have pulmonary involvement, which has been rarely reported in pediatric patients. Down syndrome (DS) has been associated with increased frequency of autoimmune diseases. However, associations between CD and DS have been rarely reported. We present the case of a 5-year-old girl with known DS and a history of chronic intermittent abdominal pain who presented with persistent pneumonia. Her workup included a chest computed tomography (CT) scan that showed multiple noncalcified pulmonary nodules. An extensive infectious workup was done that was negative. CT-guided needle biopsy of the lung nodules showed necrotizing granulomas. This raised concern for primary CD with extraintestinal pulmonary manifestation. An esophagogastroduodenoscopy and colonoscopy were performed, and colon biopsies showed scattered epithelioid granulomas. Based on this information, there was consensus that her lung nodules were secondary to CD. She was started on standard therapy for CD, and her abdominal and respiratory symptoms gradually improved. However, she continues to have mild residual lung calcification and fibrosis. To our knowledge, this is the first reported case of pulmonary CD in a child with DS. The natural history of pulmonary CD in the pediatric population is not very well studied. Furthermore, since DS has been well known to be associated with increased frequency of malignancies and autoimmune conditions due to immune dysregulation, it is difficult to predict the severity and possible complications in this patient.

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Perinuclear Antineutrophil Cytoplasmic Antibodies Vasculitis Presenting as Pulmonary-Renal Syndrome in a Patient With a History of Seropositive Rheumatoid Arthritis

JCR Journal of Clinical Rheumatology ◽

10.1097/rhu.0000000000001187 ◽

2019 ◽

Vol 27 (1) ◽

pp. e2-e3

Author(s):

Serafeim-Chrysovalantis Kotoulas ◽

Georgios Pilianidis ◽

Styliani Paschou ◽

Nikolaos Petridis ◽

Athanasia Apsemidou ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Antineutrophil Cytoplasmic Antibodies ◽

Seropositive Rheumatoid Arthritis ◽

History Of ◽

Pulmonary Renal Syndrome

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Chronic Inhalation Study Findings as a Basis for Proposing a New Occupational Dust Exposure Limit

Journal of the American College of Toxicology ◽

10.3109/10915819109078637 ◽

1991 ◽

Vol 10 (2) ◽

pp. 279-290 ◽

Cited By ~ 34

Author(s):

P. E. Morrow ◽

H. Muhle ◽

R. Mermelstein

Keyword(s):

Experimental Studies ◽

Threshold Limit Value ◽

Dust Exposure ◽

Inhalation Study ◽

Limit Value ◽

Exposure Limit ◽

History Of ◽

Current Threshold ◽

Occupational Dust Exposure ◽

Occupational Standards

This article briefly reviews the history of the current threshold limit value and the permissible exposure limit for occupational dusts derived originally from the Nuisance Dust standard. Chronic inhalation studies of appropriate design are described in terms of their key findings and potential impact on the dust standards, especially modern, experimental studies which have been affected by the problem of dust overloading. Many studies show that dust overloading produces a significant and progressive retardation of macrophage-mediated dust removal leading to various dysfunctional and pathologic changes which confound the interpretation of chronic toxicity study findings. Assuming that there may be a human counterpart to this condition at the same milligram dust per gram lung concentration, extrapolation modeling can be used to show that the current occupational dust limits do not protect worker lungs from this eventuality. Several bases for substantially reducing the current occupational standards are discussed.

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218 Rheumatoid pulmonary nodules as a risk for seropositive rheumatoid arthritis: a reappraisal of the risk of Caplan’s syndrome for rheumatoid arthritis development using historic Cornish data

Rheumatology ◽

10.1093/rheumatology/key075.442 ◽

2018 ◽

Vol 57 (suppl_3) ◽

Author(s):

Emily K Sinha-Royle ◽

David Hutchinson

Keyword(s):

Rheumatoid Arthritis ◽

Pulmonary Nodules ◽

Rheumatoid Arthritis Development ◽

Seropositive Rheumatoid Arthritis

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Granulomatosis polyangiitis

BMJ Case Reports ◽

10.1136/bcr-2018-228693 ◽

2019 ◽

Vol 12 (7) ◽

pp. e228693

Author(s):

Mustafa Sowida

Keyword(s):

Weight Loss ◽

Pulmonary Nodules ◽

Mediastinal Lymphadenopathy ◽

Lung Nodules ◽

High Dose ◽

Proteinase 3 ◽

Oral Medicine ◽

Intravenous Methylprednisolone ◽

Unexplained Weight Loss ◽

History Of

A 22-year-old female patient was admitted to hospital after being referred from the oral medicine clinic where she had been seen for persistent gingivitis and mouth ulcers. She described an insidious history of persistent fevers, dry cough and unexplained weight loss over 4–6 weeks. Imaging showed extensive bilateral pulmonary nodules with mediastinal lymphadenopathy and two lesions in the pancreas. MRI revealed these lesions to be well-defined fluid-filled cysts in the tail of the pancreas, without features of malignancy. Core biopsies taken from her lung nodules demonstrated features of vasculitis with granulomata. This was consistent with her positive immunology for c-antinuclear cytoplasmic antibodies and proteinase-3, which were sent after her fever failed to settle with antibiotic treatment. In keeping with a diagnosis of vasculitis, the patient showed a significant clinical and biochemical response to intravenous methylprednisolone and high-dose daily prednisolone thereafter.

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E32. The Rise and Fall of Seropositive Rheumatoid Arthritis: Exposure to Cadmium is a Plausible Explanation for the Natural History of Seropositive Rheumatoid Arthritis

Rheumatology ◽

10.1093/rheumatology/kev091.032 ◽

2015 ◽

Keyword(s):

Rheumatoid Arthritis ◽

Natural History ◽

Seropositive Rheumatoid Arthritis ◽

History Of

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Association between Occupational and Radiological Factors and Nontuberculous Mycobacteria Lung Infection in Workers with Prior Dust Exposure

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph16111966 ◽

2019 ◽

Vol 16 (11) ◽

pp. 1966

Author(s):

Ji-Won Lee ◽

Jun-Pyo Myong

Keyword(s):

Nontuberculous Mycobacteria ◽

Lung Infection ◽

Tertiary Hospital ◽

Cross Sectional Study ◽

Dust Exposure ◽

International Labor Organization ◽

Cross Sectional ◽

Bronchial Wash ◽

History Of ◽

Occupational Dust Exposure

This retrospective cross-sectional study was conducted to identify the factors that promote the risk of nontuberculous mycobacteria (NTM) lung infection in subjects with prior occupational dust exposure. All consecutive patients with a history of occupational dust exposure whose expectorated sputum, bronchial wash, or bronchial lavage was subjected to acid-fast Bacilli culture in a tertiary hospital between 2011 and 2016 were identified. The patients who were infected with NTM were identified according to the bacteriological criteria of the American Thoracic Society (ATS) and The Infectious Diseases Society of America (IDSA) statement. Pneumoconiosis-associated radiological findings were graded according to the International Labor Organization guidelines. Of the 1392 patients with prior dust exposure, NTM was isolated from 82. Logistic regression analysis showed that risk factors for NTM lung infection were a history of pulmonary tuberculosis (adjusted odds ratio [aOR] = 1.82, 95% confidence intervals [CI] = 1.03–3.16). Moreover, the unadjusted odds ratios (ORs) were higher when both small-opacity profusion and the large-opacity grades increased. Even after adjustment, the ORs for the A, B, and C large-opacity grades were 2.32 (95% CI = 1.01–4.99), 2.68 (95% CI = 1.35–5.24), and 7.58 (95% CI = 3.02–17.95). Previous tuberculosis, bronchiectasis, and especially extensive small-opacity profusion, and high large-opacity grade associated significantly with NTM lung infection in dust-exposed workers.

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