Progressive cavitating pulmonary changes in rheumatoid arthritis: a case report.

Abstract

SUMMARY Progressive cavitating changes in the lung apices were found in a middle-aged man with seropositive rheumatoid arthritis. These findings were attributed at autopsy to a combination of nodule-type formation, necrosis, and mild fibrosis.Pleuropulmonary complications in rheumatoid arthritis (RA) include an increased incidence of infections, pleuritis, sterile empyemas, nodules, and fibrosis.' 2 Cavitation, particularly of pulmonary rheumatoid nodules, has been described,3'-0 but we report here a patient exhibiting an unusual progressive and extensive bilateral cavitary process. He smoked 10 cigarettes daily, and except for some white sputum in the morning he had no pulmonary complaints. Recurrent bronchitis was known in the family, and his mother had RA.In 1976 he was admitted to a nearby hospital with a lung abscess and empyema from which a haemolytic streptococcus was cultured. Despite initial therapy with Ampiclox (ampicillin 250 mg and cloxacillin 250 mg) and closed pleural drainage the empyema persisted, and subsequently right lower lobectomy and decortication were necessary. There followed an