BACKGROUND: Caplan originally described a condition, now reffered to as Caplan's syndrome or Caplan's disease, where progressive massive fibrosis was exhibited by coal miners with multiple pulmonary nodules, and rheumatoid arthritis. This syndrome is very rare in Korea. CASE REPORT: The patient was a 49-year old male, with occupational history as a stonemason for 25 years. Silicosis was diagnosed by chest X-ray, while rheumatoid arthritis was diagnosed by immunological examination. Caplan's syndrome was confirmed based on these findings, occupational history, and clinical symptoms. DISCUSSION: The authors report on the patient's Caplan's syndrome, with a particular focus on his silicosis.
Arthritis, Rheumatoid ; Caplan Syndrome ; Coal ; Fibrosis ; Humans ; Korea ; Male ; Multiple Pulmonary Nodules ; Pneumoconiosis ; Silicosis ; Thorax

Caplan originally described distinctive pulmonary nodules in miners who had suffered from rheumatoid arthritis. Later, the pulmonary nodules, together with a history of rheumatoid arthritis and exposure to inorganic dust were called Caplan's syndrome. This syndrome has been described by case reports in many countries but only two cases have been reported in Korea up to now. The patient in this case report was a 70-years-old man who had worked in the construction field for 20 years mainly demolishing buildings. He was diagnosed with silicosis by a lung biopsy 1 year prior to admission. He suddenly developed arthralgia and morning stiffness in multiple joints 2 weeks prior to admission. Chest imaging revealed aggravation of the bilateral pulmonary nodules. He was diagnosed with seropositive rheumatoid arthritis. The lung nodules, arthralgia, and morning stiffness improved clinically after treatment with the corticosteroid and disease modifying anti-rheumatic drugs.
Antirheumatic Agents ; Arthralgia ; Arthritis ; Arthritis, Rheumatoid ; Biopsy ; Caplan Syndrome ; Dust ; Humans ; Joints ; Korea ; Lung ; Pneumoconiosis ; Silicosis ; Thorax

Caplan's syndrome is characterized by multiple small distinct nodules with progressive massive fibrosis and rheumatic arthritis in pneumoconiosis. Although pleural effusions occur infrequently as an extra-articular manifestation, pleuritis can develop without joint involvement in patients with rheumatoid arthritis. We treated an 81-year-old man who had been diagnosed with silicosis with progressive massive fibrosis. He suffered from progressive dyspnea, and chest computed tomography (CT) and echocardiography revealed pleural and pericardial effusions. We speculated that the multiple serositis was related to a rheumatic disorder because the rheumatic factor was elevated in both the pleural and pericardial effusions. After corticosteroid treatment, the serositis improved. We suggest that this case is an atypical pattern of Caplan's syndrome presenting as serositis without arthritis. Rheumatoid serositis should be considered as the cause of pleural or pericardial effusions in patients with pneumoconiosis.
Arthritis ; Arthritis, Rheumatoid ; Caplan Syndrome ; Dyspnea ; Echocardiography ; Fibrosis ; Humans ; Joints ; Pericardial Effusion ; Pericarditis ; Pleural Effusion ; Pleurisy ; Pneumoconiosis ; Rheumatic Fever ; Serositis ; Silicosis ; Thorax

We report a case of Caplan's Syndrome, which presented as multiple pulmonary nodules. A 58-year-old male was admitted to hospital due to multiple pulmonary nodules. In addition, the patient presented with multiple arthritis, and dyspnea on exertion. Rheumatoid arthritis had been diagnosed 35 years ago. The patient had worked as a stonemason for 20 years. Computed Tomography (CT) revealed numerous well-defined tiny nodules scattered in both lungs, which was suspicious of miliary tuberculosis or malignancy. The patient was started on antituberculous medications and referred to our hospital. First, a transbronchial lung biopsy was performed, which showed no evidence of granuloma. It was our opinion that the biopsy was insufficient, and a follow-up video-associated thoracoscopy was performed. The pathological report determined necrotizing granulomatous inflammation and silicosis on background. According to imaging studies, pathologic reports, and clinical symptoms, we concluded that the patient had Caplan's syndrome. We controlled his rheumatic medications, and instructed him to avoid exposure to hazardous dust.
Arthritis ; Arthritis, Rheumatoid ; Biopsy ; Caplan Syndrome ; Dust ; Dyspnea ; Follow-Up Studies ; Granuloma ; Humans ; Inflammation ; Lung ; Male ; Middle Aged ; Multiple Pulmonary Nodules ; Silicosis ; Thoracoscopy ; Tuberculosis, Miliary