J Rheum Dis.  2016 Dec;23(6):392-395. 10.4078/jrd.2016.23.6.392.

Case of Follicular Bronchiolitis in Rheumatoid Arthritis

• Lee JH
• Choi M
• Oh SS
• Choi MR
• Yang HJ
• Lee KM
• Choi KH

• KMID: 2364694
• DOI: http://doi.org/10.4078/jrd.2016.23.6.392

Abstract

Follicular bronchiolitis is an uncommon bronchiolar disorder that is characterized by the presence of hyperplastic lymphoid follicles with reactive germinal centers. The condition is associated with connective tissue diseases such as rheumatoid arthritis, Sjögren's syndrome, and immunodeficiency disorders. A 56-year-old man with rheumatoid arthritis was admitted to hospital with a progressively enlarging pulmonary nodule in the left upper lobe. A follow-up contrast tomography scan showed that the nodule had increased in size from 4.2 mm to 6.3 mm over a 3 month period. An open lung biopsy was performed to establish a definite pathologic diagnosis of the pulmonary nodule, which was suspected to be a lung malignancy. The nodule was diagnosed as follicular bronchiolitis based on the histopathology findings. We describe a patient with follicular bronchiolitis that was confirmed by an open lung biopsy, and is believed to have had rheumatoid involvement.

Keyword

Bronchiolitis; Solitary pulmonary nodule; Arthritis rheumatoid

MeSH Terms

Arthritis, Rheumatoid*
Biopsy
Bronchiolitis*
Connective Tissue Diseases
Diagnosis
Follow-Up Studies
Germinal Center
Humans
Lung
Middle Aged
Solitary Pulmonary Nodule

Figure

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  Figure 1. The chest radiograph revealed linear densities and small nodules bilaterally in the lower lung fields.

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  Figure 2. Chest computed tomography revealed (A) linear, reticular densities and ground glass opacities in the bilateral lower lung fields, as well as (B and C) a slightly increased nodule (that had increased in size from 4.2 mm to 6.3 mm) in the apicoposterior segment of the left upper lobe.

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  Figure 3. Histologic specimen showing (A) hyperplasia of the lymphoid follicle (H&E, ×40) and (B) a benign hyperplastic germinal center (H&E, ×100).

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