2015
DOI: 10.1590/abd1806-4841.20153750
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Abstract: We report the case of a 42-year-old female with a 5-year history of rheumatoid arthritis treated with Rituximab and Azathioprine. Three months after the initiation of Azathioprine, the patient started with dry cough and noted the rapid development of multiple subcutaneous nodules on her right leg. CT scan of the chest demonstrates pulmonary nodulosis. Skin biopsy was compatible with rheumatoid nodule. A diagnosis of "accelerated cutaneous and pulmonary nodulosis" was considered. Azathioprine was discontinued a… Show more

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Cited by 11 publications
(8 citation statements)
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“…Rheumatoid nodules can rupture into the pleural cavity and cause pneumothorax, empyema, and bronchopleural fistula (BPF). Some reports also indicate that rapid growth of rheumatoid nodules may be associated with azathioprine treatment [ 6 ] or biological therapies [ 7 ] of RA. Kim et al also reported a case of recurrent pneumothorax after etanercept therapy induced by the progression of interstitial lung disease [ 8 ].…”
Section: Case Presentationmentioning
confidence: 99%
“…Rheumatoid nodules can rupture into the pleural cavity and cause pneumothorax, empyema, and bronchopleural fistula (BPF). Some reports also indicate that rapid growth of rheumatoid nodules may be associated with azathioprine treatment [ 6 ] or biological therapies [ 7 ] of RA. Kim et al also reported a case of recurrent pneumothorax after etanercept therapy induced by the progression of interstitial lung disease [ 8 ].…”
Section: Case Presentationmentioning
confidence: 99%
“…Rheumatoid nodules are the most frequent extra‐articular manifestation of rheumatoid arthritis (RA), affecting up to 35% of patients 1–3 . Typically, they develop on extensor surfaces involving pressure points, such as the olecranon process, proximal ulna, digital proximal tendon sheaths, and Achilles tendons, although they may also be found in visceral organs, such as the lungs 4,5 . On the other hand, the term “accelerated nodulosis” refers to the rapid progression and/or extension of new or preexisting nodules.…”
Section: Introductionmentioning
confidence: 99%
“…The development of extensive nodulosis during MTX therapy in patients with diseases other than RA is rare, 9 but reports include psoriatic arthritis (PsA), 19,20 systemic lupus erythematous (SLE), 21 and juvenile idiopathic arthritis (JIA) 22 . Accelerated nodulosis has also been reported in association with other drugs, such as tumor necrosis factor (TNF alpha) inhbitors, 14,23–25 azathioprine, 5,26 leflunomide, 9,27 aromatase inhbitors, 28 and tocilizumab 5,9,24,26,28–30 . Therefore, some have proposed the terminology “immunomodulatory agents induced nodulosis.” 31 There are several predisposing factors, such as male gender, smoking, high titers of rheumatoid factor (RF) and anticitrullinated protein antibodies (ACPA), severe articular disease, and genetic susceptibility (HLA‐DRB1) 10,23,29,31 …”
Section: Introductionmentioning
confidence: 99%
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