Rheumatoid Necrobiotic Nodules with Air Crescent Appearance Associated with Caplan Syndrome: A Case Report

Abstract

Introduction: Rheumatoid nodules in the lung are an infrequentmanifestation of rheumatoid arthritis. Here we present a case report of necrobiotic nodules with cavitation with air crescentappearance in chest computed tomography. Case description: A 63-year-old male, construction worker, presented to theemergency room with progressive dyspnea and cough. Chest computed tomography showed multiple nodular lesions of randomdistribution, some of them with cavitation in multiple layers, resemblant to air crescents between them. Open lung biopsy showeddistortion of lung architecture and nodular formations with necrotic centers, surrounded by histiocytes with foreign body inclusions,compatible with Caplan syndrome. Discussion: In this case report we illustrated an unusual lung manifestation of rheumatoidarthritis associated with silica exposure. Caplan syndrome diagnosis is usually made by radiological assessment and exclusionof differential diagnosis by microbiological and histopathological samples. Features of cavitation in the nodules of this case hadthe appearance of crescents of air between multiple layers. Keywords: Caplan Syndrome; Rheumatoid Arthritis; Lung Diseases,InterstitialThis abstract is funded by: NoneAm J Respir Crit Care Med 2022;205:A1365Internet address: www.atsjournals.orgOnline Abstracts Issue