A Case of Rheumatoid Arthritis with Eosinophilia and Aspergilloma within the Lung Nodule Resulting in Bronchopleural Fistula.
- Author:
Hyo Sook PARK
;
Mi Kyoung LIM
;
Hye Soon LEE
;
Sung Soon LEE
;
Chan KIM
;
Ki Man LEE
;
Bin YOO
;
Youn Sock KOH
;
Kwang Hyun HSON
;
Hee Bom MOON
- Publication Type:Case Report
- Keywords:
Rheumatoid arthritis;
Eosinophilia;
rheumatoid lung nodule;
Aspergilloma;
Pneumothorax
- MeSH:
Adult;
Arthritis, Rheumatoid*;
Aspergillus fumigatus;
Bacillus;
Biopsy, Needle;
Chest Pain;
Cough;
Drainage;
Dyspnea;
Eosinophilia*;
Eosinophils;
Fever;
Fistula*;
Fungi;
Humans;
Hydropneumothorax;
Lung*;
Necrosis;
Needles;
Pleural Cavity;
Pneumothorax;
Pseudomonas;
Thoracotomy;
Thorax
- From:Korean Journal of Medicine
1997;53(5):720-726
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
The lung nodule is one of the pleuropulmonary menifestations in rheumatoid arthritis. We report here a case exhibiting hydropneumothorax due to a bronchoplerual fistula resulting from a ruptured rheumatoid lung nodule complicated with a aspergilloma in it. A 39 year-old man with rheumatoid arthritis was admitted because of cough for one month. Multiple subcutaneous nodules were noted and multiple lung nodules were seen on chest X-ray, Peripheral white cells were 9,600/mm3 with 1896 of eosinophils. The percutaneous needle aspiration biopsy of the largest lung nodule of right upper lobe showed massive necrosis without acid fast bacillus, fungus, or malignant cell. Three months after discharge, air-meniscus sign was seen on the biopsied lung nodule on X-ray. Five months later, the patient was readmitted due to dyspnea and chest pain and simple chest X-ray showed hydropneumothorax on the right side. The pneumothorax was not healed after closed thoracotomy and tube drainage, and high fever developed. The pleural fluid culture revealed Pseudomonas aeroginosa and Aspergillus fumigatus. Seventy days after admission, exploratory thoracotomy was done. Aspergilloma was found in the cavitated lung nodule which was ruptured into the pleural cavity through bronchopleural fistula.
