Cavazza A, Paci M, Turrini E, Dallari R, Rossi G
J Clin Pathol. 2003 Aug;56(8):636-7. doi: 10.1136/jcp.56.8.636.
This report describes a 69 year old woman, suffering from active rheumatoid arthritis since the age of 60 and presenting with severe dyspnoea and cough. A computed tomography scan of the chest showed multiple bilateral pulmonary nodules, sometimes cavitated, associated with reticular opacities and pleural effusion. A videothoracoscopic excision of a cavitated nodule was performed. Seven days after surgery, a right pneumothorax developed, and the patient died of septicaemia one month later. Microscopically, the excised nodule was composed of necrotic fibrinoid material with a peripheral rim of palisaded histiocytes, extending to the pleural surface and containing several fungal hyphae morphologically consistent with aspergillus. A diagnosis of pulmonary rheumatoid nodule with fungus colonisation was made. In the lung, fungus colonisation is a rare complication of rheumatoid nodules. The most important differential diagnostic considerations are briefly discussed.
本报告描述了一名69岁女性，自60岁起患有活动性类风湿关节炎，出现严重呼吸困难和咳嗽。胸部计算机断层扫描显示双侧多个肺结节，有时有空洞形成，伴有网状阴影和胸腔积液。对一个有空洞的结节进行了电视胸腔镜切除。术后7天出现右侧气胸，患者1个月后死于败血症。显微镜下，切除的结节由坏死的纤维蛋白样物质组成，周边有栅栏状组织细胞环绕，延伸至胸膜表面，并含有数条形态与曲霉菌一致的真菌菌丝。诊断为肺部类风湿结节伴真菌定植。在肺部，真菌定植是类风湿结节的一种罕见并发症。文中简要讨论了最重要的鉴别诊断要点。
