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Bilateral hydropneumothoraces in a patient with pulmonary rheumatoid nodules during treatment with methotrexate
  1. N Steeghs1,
  2. T W J Huizinga2,
  3. H Dik3
  1. 1Department of Internal Medicine, Rijnland Hospital, Leiderdorp, the Netherlands
  2. 2Department of Rheumatology, Leiden Medical Centre, Leiden, the Netherlands
  3. 3Department of Pulmonary Medicine, Rijnland Hospital, Leiderdorp, the Netherlands
  1. Correspondence to:
    MrsN Steeghs
    Department of Internal Medicine C1-R41, University Hospital, Albinusdreef 2, PO box 9600, 2300 RC Leiden, The Netherlands; n.steeghslumc.nl

https://doi.org/10.1136/ard.2004.032011

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    Extra-articular manifestations in rheumatoid arthritis (RA), in particular rheumatoid nodules, are common. The most common pulmonary manifestations are pleural abnormalities and interstitial lung disease.1 Nodules observed on a chest x ray examination are a well known diagnostic dilemma in patients with RA, given the differential diagnosis of malignancy and rheumatoid nodules. Spontaneous pneumothorax secondary to pulmonary rheumatoid nodules is an uncommon complication of RA.2,3

    A 73 year old female patient was admitted for cough, fever, and dyspnoea. She had had seropositive RA for 15 years, and had a history of chronic bronchitis, heart failure, diabetes mellitus, and hypothyroidism. She had been treated for 1 year with prednisone 7.5 mg/day and methotrexate (MTX), for active arthritis. The MTX dose was raised to 12.5 mg/week a month before presentation.

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