Voulgari P V, Tsifetaki N, Metafratzi Z M, Zioga A, Acritidis N C, Drosos A A
Rheumatology Clinic, Department of Internal Medicine, Medical School, University of Ioannina, Ioannina, Greece.
Clin Rheumatol. 2005 Sep;24(5):556-9. doi: 10.1007/s10067-005-1091-z. Epub 2005 May 21.
We present a 54-year-old man, a heavy smoker, with clinical and laboratory evidence of familial hypercholesterolemia and an asymptomatic solitary pulmonary nodule (SPN) increasing in size on follow-up chest X-ray. Laboratory work-up revealed high titers of rheumatoid factor and the presence of acute phase reactants. Because of the patient's age and history of smoking, open lung biopsy was performed to rule out malignancy. The biopsy showed histological features compatible with a rheumatoid nodule. Identical features were noted in the histological examination of the subcutaneous nodule. Usually, rheumatoid nodules occur in patients with active, long-standing rheumatoid arthritis (RA) with other extra-articular manifestations. The presence of a single pulmonary rheumatoid nodule as the first manifestation of RA is extremely rare. Histologic proof is often required since pulmonary carcinoma can present an identical clinical and radiological pattern. The diagnostic work-up and the differential diagnosis of an SPN, particularly in a heavy smoker, is a common clinical request and remains a diagnostic challenge.
我们报告一名54岁男性，重度吸烟者，有家族性高胆固醇血症的临床和实验室证据，且在随访胸部X线检查中发现一个无症状的孤立性肺结节（SPN）大小增大。实验室检查显示类风湿因子高滴度以及急性期反应物的存在。由于患者的年龄和吸烟史，进行了开胸肺活检以排除恶性肿瘤。活检显示组织学特征与类风湿结节相符。皮下结节的组织学检查也发现了相同特征。通常，类风湿结节发生于患有活动性、长期类风湿关节炎（RA）且有其他关节外表现的患者。单个肺类风湿结节作为RA的首发表现极为罕见。由于肺癌可能呈现相同的临床和放射学表现，通常需要组织学证据。对SPN进行诊断检查和鉴别诊断，尤其是在重度吸烟者中，是常见的临床需求，并且仍然是一个诊断挑战。
