Pulmonary Rheumatoid Nodules: A Case Report

Rheumatoid arthritis (RA) is an autoimmune disorder primarily targeting joints, with the lungs often being the most affected organ outside the joints. Pulmonary rheumatoid nodules (PRNs) are unusual manifestations of RA in the lungs. We report a case of a 74-year-old Chinese man with a smoking history, diagnosed with RA and treated with leflunomide and prednisone, who showed multiple peripheral or pleural nodules in both lungs on computed tomography (CT) scans. Pathological analysis of the right middle lobe lesion from CT-guided percutaneous core needle biopsy showed lymphocytic and neutrophilic infiltration, eosinophilic necrosis, scattered multinucleated giant cells and no basophilic necrosis or vasculitis. The diagnosis of PRNs was made after thorough examinations and multidisciplinary consultation and tocilizumab was recommended for subsequent therapy. PRNs, a rare extra-articular manifestation of RA, should be distinguished from infections and malignancies. High-resolution chest CT and biopsy can help in the diagnosis.