Eosinophilic pneumonia with nodular shadows in a patient with rheumatoid arthritis

We report a rare case of eosinophilic pneumonia with nodules, which required a differential diagnosis of lung cancer. She had been treated for rheumatoid arthritis and bronchial asthma for eight years. Although there were no exacerbations of symptoms of rheumatism, newly development of nodules and ground-glass opacities in both upper lobes of the lung were found in the chest CT scan. A bronchoalveolar lavage obtained from the right middle lobe showed 58.8% eosinophils. The transbronchial biopsy from the lesion of the nodular shadow could not be performed because the patient developed an asthma attack during the examination of bronchoscopy. Chest CT scan performed one month after the start of prednisolone treatment showed that not only GGOs but also nodules showed shrinkage or almost disappeared. In some patients with eosinophilic pneumonia, there may be nodules that need to be differentiated from lung cancer. In such cases, the presence of GGOs around the nodule might be an important finding in imaging examination. To confirm the diagnosis, performing a tissue biopsy should be actively considered. Patients with eosinophilic pneumonia might also have bronchial asthma, and attention should be paid to the onset of asthma attacks during bronchoscopy.