Tuberc Respir Dis.  2011 Feb;70(2):150-154. 10.4046/trd.2011.70.2.150.

Caplan's Syndrome Presenting as Multiple Pulmonary Nodules

• Lee SK
• Lee SH
• Kim SY
• Lee WK
• Shin DH
• Bang WD
• Noh SM
• Shim HS
• Park BH
• Lee KJ
• Park MS
• Kim YS
• Chang J
• Kim SK
• Kang YA

• KMID: 1442865
• DOI: http://doi.org/10.4046/trd.2011.70.2.150

Abstract

We report a case of Caplan's Syndrome, which presented as multiple pulmonary nodules. A 58-year-old male was admitted to hospital due to multiple pulmonary nodules. In addition, the patient presented with multiple arthritis, and dyspnea on exertion. Rheumatoid arthritis had been diagnosed 35 years ago. The patient had worked as a stonemason for 20 years. Computed Tomography (CT) revealed numerous well-defined tiny nodules scattered in both lungs, which was suspicious of miliary tuberculosis or malignancy. The patient was started on antituberculous medications and referred to our hospital. First, a transbronchial lung biopsy was performed, which showed no evidence of granuloma. It was our opinion that the biopsy was insufficient, and a follow-up video-associated thoracoscopy was performed. The pathological report determined necrotizing granulomatous inflammation and silicosis on background. According to imaging studies, pathologic reports, and clinical symptoms, we concluded that the patient had Caplan's syndrome. We controlled his rheumatic medications, and instructed him to avoid exposure to hazardous dust.

Keyword

Caplan Syndrome; Multiple Pulmonary Nodules; Arthritis, Rheumatoid

MeSH Terms

Arthritis
Arthritis, Rheumatoid
Biopsy
Caplan Syndrome
Dust
Dyspnea
Follow-Up Studies
Granuloma
Humans
Inflammation
Lung
Male
Middle Aged
Multiple Pulmonary Nodules
Silicosis
Thoracoscopy
Tuberculosis, Miliary
Dust

Figure

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  Figure 1 The initial chest X-ray showed multiple nodular opacities in the whole lung field.

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  Figure 2 The chest computer tomography (CT) revealed numerous well-defined tiny nodules scattered in both lungs with perilymphatic distribution.

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  Figure 3 The PET-CT showed uptake in lung parenchyma, pleura, hilar lymph nodes and mediastinal lymph nodes. PET: positron emission tomography; CT: computer tomography.

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  Figure 4 This slide showed silicotic nodule in background (A: Hematoxylin and Eosin stain, ×40) and accumulation of dust-laden macrophages (B: Hematoxylin and Eosin stain, ×200).

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