García-Vicuña R, Díaz-González F, Castañeda S, Arranz M, López-Bote J P
Seccion de Reumatologia, Hospital de la Princesa, Universidad Autónoma de Madrid, Spain.
J Rheumatol. 1990 Dec;17(12):1686-8.
We describe a 67-year-old man with severe rheumatoid arthritis of long duration. He developed a peculiar extraarticular rheumatoid complication consisting of localized lung consolidation with a pathological costal fracture, together with an abrupt systemic reaction that occurred in the course of immunosuppressive treatment. The diagnosis first proposed was lung cancer with costal metastases. However exhaustive studies performed in the search of malignancy were systematically negative and pathologic studies finally demonstrated bronchiolitis obliterans with organizing pneumonia (BOOP) as responsible for parenchymal lung consolidation with a rheumatoid nodule eroding bone at the level of the rib fracture. These findings, after long followup of the patient, attest to the rheumatoid origin of his bizarre manifestations and definitely rule out a neoplastic etiology.
我们描述了一位患有长期严重类风湿性关节炎的67岁男性。他出现了一种特殊的关节外类风湿并发症，包括局限性肺实变伴病理性肋骨骨折，以及在免疫抑制治疗过程中发生的突然全身反应。最初提出的诊断是肺癌伴肋骨转移。然而，为寻找恶性肿瘤而进行的详尽研究均系统地呈阴性，病理研究最终表明闭塞性细支气管炎伴机化性肺炎（BOOP）是导致肺实质实变的原因，在肋骨骨折处有一个类风湿结节侵蚀骨质。对该患者进行长期随访后的这些发现，证实了他这些奇异表现的类风湿起源，并明确排除了肿瘤病因。
