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[Follicular bronchiolitis preceding rheumatoid arthritis]
Masaharu Nagayama1, Kingo Chida, Mikio Toyoshima
1Department of Internal Medicine, Hamaoka Municipal Hospital, 2060, Hamaoka, Shizuoka, 437-1696, Japan.
Summary
A woman with a history of lung issues developed severe respiratory symptoms. Diagnosis revealed follicular bronchiolitis, a rare inflammatory lung condition, after initial treatments failed.
Area of Science:
- Pulmonology
- Rheumatology
- Pathology
Background:
- A 52-year-old woman with a history of non-tuberculous mycobacteriosis and chronic sinusitis presented with cough and stridor.
- Initial chest CT scans suggested recurrent non-tuberculous mycobacteriosis or diffuse panbronchiolitis.
Observation:
- The patient's respiratory symptoms persisted despite clarithromycin treatment and later, a combination of rifampicin, ethambutol hydrochloride, and clarithromycin.
- Rheumatoid arthritis was diagnosed one year after initiating antituberculous therapy, indicated by swollen interphalangeal joints.
Findings:
- Histological examination via thoracoscopic biopsy confirmed follicular bronchiolitis as the underlying cause of her respiratory symptoms.
- This diagnosis was made after extensive imaging and empirical treatments failed to alleviate her condition.
Implications:
- Follicular bronchiolitis can present with symptoms mimicking other lung diseases, necessitating thorough diagnostic evaluation.
- This case highlights the importance of considering inflammatory lung conditions in patients with complex respiratory symptoms and autoimmune markers.