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Case ReportImages in Rheumatology

Cryptogenic Organizing Pneumonia Mimicking Malignancy in a Patient with Rheumatoid Arthritis

MARIA KONSTA, VASSILIKI-KALLIOPI BOURNIA, PARASKEVI ALEXANDROU and ALEXIOS ILIOPOULOS
The Journal of Rheumatology September 2011, 38 (9) 2007-2008; DOI: https://doi.org/10.3899/jrheum.110282
MARIA KONSTA
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  • For correspondence: markonsta@hotmail.com
VASSILIKI-KALLIOPI BOURNIA
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PARASKEVI ALEXANDROU
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ALEXIOS ILIOPOULOS
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A 53-year-old woman with an 8-year history of rheumatoid arthritis (RA) presented with fatigue and malaise. She had no evidence of tender or swollen joints. Laboratory investigations revealed anemia (hemoglobin 10.2 g/dl) of recent onset and an unexpectedly elevated erythrocyte sedimentation rate (114 mm/h). A chest radiograph showed a well defined noncalcified solitary mass in the right lung (Figure 1). High-resolution computed tomography (CT) of the lungs revealed a spiculated lung in the upper right lobe, with a diameter of about 4 cm (Figure 2). The patient was a smoker (half-pack daily for 20 years) and in view of these findings open lung biopsy was performed to rule out malignancy. The biopsy showed histological features compatible with cryptogenic organizing pneumonia (COP; Figure 3). The patient was started on oral methylprednisolone 0.75 mg/kg/day, with great improvement of symptoms and radiologic and laboratory findings in the following month.

Figure 1.
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Figure 1.

Chest radiograph showing a mass in the right lung.

Figure 2.
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Figure 2.

CT of the lung showing a round homogeneous mass with irregular border in the right upper lobe.

Figure 3.
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Figure 3.

Open lung biopsy specimen showing fibroblastic proliferation plugs within alveolar spaces (“COP pattern”); H&E stain, original magnification ×200.

A patient with RA and a focal pulmonary opacity represents a difficult diagnostic dilemma, especially when confounded by a history of smoking and immunosuppression1. The presentation of COP as a solitary focal lesion is rare2, requiring lung biopsy to establish the diagnosis and to exclude the possibility of malignancy3.

REFERENCES

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    1. Voulgari PV,
    2. Tsifetaki N,
    3. Metafratzi ZM,
    4. Zioga A,
    5. Acritidis NC,
    6. Drosos AA
    . A single pulmonary rheumatoid nodule masquerading as malignancy. Clin Rheumatol 2005;24:556–9.
    OpenUrlCrossRefPubMed
  2. 2.↵
    1. Cordier JF
    . Organizing pneumonia. Thorax 2000;55:318–28.
    OpenUrlFREE Full Text
  3. 3.↵
    1. Gould MK,
    2. Fletcher J,
    3. Iannettoni MD,
    4. Lynch WR,
    5. Midthun DE,
    6. Naidich DP,
    7. et al;
    8. American College of Chest Physicians
    . Evaluation of patients with pulmonary nodules: when is it lung cancer? ACCP evidence-based clinical practice guidelines (2nd edition). Chest 2007;132 Suppl 3:108–30.
    OpenUrlCrossRef
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The Journal of Rheumatology
Vol. 38, Issue 9
1 Sep 2011
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Cryptogenic Organizing Pneumonia Mimicking Malignancy in a Patient with Rheumatoid Arthritis
MARIA KONSTA, VASSILIKI-KALLIOPI BOURNIA, PARASKEVI ALEXANDROU, ALEXIOS ILIOPOULOS
The Journal of Rheumatology Sep 2011, 38 (9) 2007-2008; DOI: 10.3899/jrheum.110282

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Cryptogenic Organizing Pneumonia Mimicking Malignancy in a Patient with Rheumatoid Arthritis
MARIA KONSTA, VASSILIKI-KALLIOPI BOURNIA, PARASKEVI ALEXANDROU, ALEXIOS ILIOPOULOS
The Journal of Rheumatology Sep 2011, 38 (9) 2007-2008; DOI: 10.3899/jrheum.110282
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