Yamamoto Natsumi, Amano Shiho, Oka Kohei, Sano Chiaki, Ohta Ryuichi
Community Care, Unnan City Hospital, Unnan, JPN.
Community Medicine Management, Shimane University Faculty of Medicine, Izumo, JPN.
Cureus. 2025 Jul 2;17(7):e87205. doi: 10.7759/cureus.87205. eCollection 2025 Jul.
This case report describes a 95-year-old woman with a history of cardiovascular and gastrointestinal diseases who presented with fever and anorexia. She was diagnosed with influenza A and secondary bacterial pneumonia. Despite antiviral and antibiotic treatment, her respiratory condition worsened. Detailed examination revealed characteristic joint deformities, elevated rheumatoid factor, and anti-cyclic citrullinated peptide antibodies. Imaging showed interstitial pneumonia and paradoxical breathing with elevation of the membranous portion of the trachea, indicating tracheomalacia. The patient was diagnosed with previously unrecognized rheumatoid arthritis with associated interstitial pneumonia and tracheomalacia. Immunosuppressive therapy with prednisolone and azathioprine improved her condition. This case highlights the importance of thorough systemic evaluation in elderly patients with unexplained respiratory symptoms and the need to consider late-onset autoimmune diseases, including rheumatoid arthritis, in the differential diagnosis.
本病例报告描述了一位95岁的女性，有心血管和胃肠道疾病史，出现发热和厌食症状。她被诊断为甲型流感和继发性细菌性肺炎。尽管进行了抗病毒和抗生素治疗，但其呼吸状况仍恶化。详细检查发现特征性关节畸形、类风湿因子升高以及抗环瓜氨酸肽抗体。影像学显示间质性肺炎和气管膜部抬高导致的矛盾呼吸，提示气管软化。该患者被诊断为先前未被认识的类风湿关节炎合并间质性肺炎和气管软化。使用泼尼松龙和硫唑嘌呤进行免疫抑制治疗改善了她的病情。本病例强调了对有不明原因呼吸道症状的老年患者进行全面系统评估的重要性，以及在鉴别诊断中考虑包括类风湿关节炎在内的迟发性自身免疫性疾病的必要性。
