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Requests for reprints should be addressed to Fabian Leo, MD, Department of Pulmonary Medicine, ELK Thorax Center (Evangelische Lungenklinik Berlin), Academic Teaching Hospital of Charité University Medicine, Lindenberger Weg 27, Berlin 13125, Germany.
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(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.
Development and validation of a consensus methodology for the classification of the ANCA-associated vasculitides and polyarteritis nodosa for epidemiological studies.
Prevalence of overlap of antineutrophil cytoplasmic antibody associated vasculitis with systemic autoimmune diseases: an unrecognized example of poliautoimmunity.
