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Bilateral Pulmonary Cavitation as Predominant Phenotype in ANCA-Associated Disease

Published:December 22, 2020DOI:https://doi.org/10.1016/j.amjmed.2020.11.018
      A 48-year-old female ex-smoker (30 pack years) with a history of lymphocytic colitis presented to a rheumatologist due to bilateral ankle pain and finger stiffness. Based on clinical and laboratory findings, rheumatoid arthritis was diagnosed. The patient reported no respiratory symptoms and no weight loss, night sweats, or febrile episodes. However, prior to intended immunosuppressive pharmacotherapy, thoracic imaging was performed. This surprisingly revealed large cavities in both lungs (Figure). Thereupon, the patient was referred to our Department of Pulmonary Medicine.
      Figure
      Figure(A) Chest radiography showing pulmonary cavitation in the upper and apical zones on the right side and in the upper zone on the left. (B) Computed tomography demonstrating thick-walled cavities in segment 1 of the right upper lobe (measuring 92 mm in diameter) and segment 1/2 of the left upper lobe (measuring 43 mm in diameter). (C) Computed tomography revealing an additional nodule (10 mm) surrounded by an area of ground glass opacity in the basal right upper lobe (arrow). Right hilar and aortopulmonary lymph node enlargement was also noted, measuring up to 15 mm and 9 mm, respectively.

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