Caplan's Syndrome Presenting as Multiple Pulmonary Nodules.

Lee, Sang Kook; Lee, Sang Hoon; Kim, Song Yee; Lee, Woo Kyung; Shin, Dong Ho; Bang, Woo Dae; Noh, Song Mi; Shim, Hyo Sup; Park, Byung Hoon; Lee, Kyung Jong; Park, Moo Suk; Kim, Young Sam; Chang, Joon; Kim, Se Kyu; Kang, Young Ae

doi:2011.70.2.150

Tuberc Respir Dis > Volume 70(2); 2011 > Article

Case Report

Tuberculosis and Respiratory Diseases 2011;70(2):150-154.
DOI: https://doi.org/10.4046/trd.2011.70.2.150 Published online February 1, 2011.

Caplan's Syndrome Presenting as Multiple Pulmonary Nodules.

Sang Kook Lee, Sang Hoon Lee, Song Yee Kim, Woo Kyung Lee, Dong Ho Shin, Woo Dae Bang, Song Mi Noh, Hyo Sup Shim, Byung Hoon Park, Kyung Jong Lee, Moo Suk Park, Young Sam Kim, Joon Chang, Se Kyu Kim, Young Ae Kang

¹Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea. mdkang@yuhs.ac
²Department of Pathology, Yonsei University College of Medicine, Seoul, Korea.
³The Institute of Chest Diseases, Yonsei University College of Medicine, Seoul, Korea.

Abstract

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.

Key Words: Caplan Syndrome, Multiple Pulmonary Nodules, Arthritis, Rheumatoid