Kumar Vinod
Pulmonary Medicine, Institute of Thoracic Medicine, Madras Medical College, Chennai, IND.
Cureus. 2025 Apr 2;17(4):e81628. doi: 10.7759/cureus.81628. eCollection 2025 Apr.
Secondary spontaneous pneumothorax is typically caused by tuberculosis or emphysema. Other causes include interstitial lung disease, pneumoconiosis, organizing pneumonias, and rare conditions like Langerhans cell histiocytosis and lymphangiomyomatosis. Rheumatoid arthritis is an uncommon cause of recurrent secondary spontaneous pneumothorax due to the rupture of subpleural necrobiotic nodules. Drugs like methotrexate and leflunomide are known to accelerate the development and progression of these necrobiotic nodules. Although the exact mechanism is unknown, it is believed to result from decreased monocyte activity and increased rheumatoid factor, with macrophages acting as a nidus that interacts with rheumatoid factor to form a nodule, ultimately leading to pneumothorax when it communicates with the pleural space. This report presents a rare case of recurrent spontaneous pneumothorax resulting from the rupture of subpleural necrobiotic nodules in a patient with rheumatoid arthritis-associated lung disease.
继发性自发性气胸通常由肺结核或肺气肿引起。其他病因包括间质性肺疾病、尘肺病、机化性肺炎以及罕见病症，如朗格汉斯细胞组织细胞增多症和淋巴管平滑肌瘤病。类风湿性关节炎是复发性继发性自发性气胸的罕见病因，系由胸膜下坏死性结节破裂所致。已知甲氨蝶呤和来氟米特等药物会加速这些坏死性结节的形成和发展。尽管确切机制尚不清楚，但据信是由于单核细胞活性降低和类风湿因子增加，巨噬细胞作为一个病灶与类风湿因子相互作用形成结节，当该结节与胸膜腔相通时最终导致气胸。本报告介绍了一例罕见的类风湿性关节炎相关肺疾病患者因胸膜下坏死性结节破裂导致复发性自发性气胸的病例。
