Pulmonary rheumatoid nodules in a patient treated with golimumab

Pulmonary rheumatoid nodules are a relatively uncommon extra-articular manifestation of rheumatoid arthritis. We report a case occurring after therapy with golimumab.

A 79-year-old woman, with a seropositive rheumatoid arthritis diagnosis since the age of 55, was under treatment with methotrexate 20mg/week since diagnosis, in combination with golimumab for the past 8 years. High-resolution computed tomography (HRCT) of the chest revealed over 60 bilateral lung nodules, multifocal, the majority with a diameter range 5-7 mm and with central cavities. A video bronchoscopy was performed: histopathology was negative for neoplastic cells, and bacteriologic, fungal and mycobacterial cultures were negative. Golimumab was suspended, maintaining only methotrexate. Chest HRCT at six months showed complete resolution of the lesions.

A diagnosis of rheumatoid nodules was made based on the clinical setting, radiographic features, cultural exams and histopathology findings. There have been reports suggesting they may develop during TNF inhibitors therapy, mainly observed with etanercept. Only one other case has been described with golimumab. Treatment discontinuation resulted in regression/stability of the lesions in most patients, as happened in our case.