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Nodular pleuropulmonary rheumatoid disease

Report of two cases and review of literature
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      Abstract

      Described herein are two patients with nodular rheumatoid pleuropulmonary disease confirmed at autopsy. In neither was there an occupational history to suggest Caplan's syndrome. In one, a sixty-two year old man, symptoms and roentgenographic findings of diffuse interstitial pulmonary fibrosis, in keeping with the Hamman-Rich syndrome, were present three years before the onset of joint complaints, the latter evolving into a crippling rheumatoid arthritis. In the other, a seventy-one year old woman, advanced rheumatoid arthritis had been present for more than twenty years before discovery of the pulmonary lesions. The course of the disease in the man was featured by recurrent spontaneous pneumothoraces, and repeated attempts at closure of the bronchopleural fistulas. Thirty-two previously reported cases of nodular, nonpneumoconiotic rheumatoid disease are tabulated and several others cited, with special reference to certain relationships of the manifestations of joint and lung involvement. On the basis of the present study and previous observations it is concluded that in some cases the Hamman-Rich syndrome reflects a rheumatoid disease even in the absence of accompanying symptoms of joint involvement.
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