Bubbles in the Box: Recurrent Pneumothorax From Bronchopleural Fistula in Rheumatoid Arthritis

When considering rheumatoid arthritis (RA)-associated pulmonary diseases, interstitial lung disease and pleural disease are the most common RA-associated pulmonary manifestations while spontaneous pneumothorax and bronchopleural fistula (BPF) are among the extremely rare ones. To the best of our kno...

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Bibliographic Details
Published in:JIM - high impact case reports 2019-01, Vol.7, p.2324709619860555-2324709619860555
Main Authors: Taha, Ahmed, Hazam, Randa, Tseng, Jim, Nahapetyan, Lusine, Alzeerah, Masoud, Islam, Asm
Format: Article
Language:English
Subjects:
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Antirheumatic Agents - therapeutic use
Arthritis, Rheumatoid - complications
Arthritis, Rheumatoid - drug therapy
Bronchial Fistula - diagnostic imaging
Bronchial Fistula - etiology
Case Report
Case reports
Female
Fistula
Humans
Lung diseases
Methotrexate - therapeutic use
Multiple Pulmonary Nodules
Pleural Diseases - diagnostic imaging
Pleural Diseases - etiology
Pneumonectomy
Pneumothorax - diagnostic imaging
Pneumothorax - etiology
Radiography, Thoracic
Recurrence
Rheumatoid arthritis
Tomography, X-Ray Computed
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Summary:When considering rheumatoid arthritis (RA)-associated pulmonary diseases, interstitial lung disease and pleural disease are the most common RA-associated pulmonary manifestations while spontaneous pneumothorax and bronchopleural fistula (BPF) are among the extremely rare ones. To the best of our knowledge, all the previous reports of RA-associated BPFs were attributed to peripherally located pulmonary nodules that necrotized, burst into the pleural cavity, and eventually lead to the fistula formation. However, we hereby present the first case of BPF in an RA patient that formed in the absence of any underlying rheumatic pulmonary nodules. Additionally, our patient was on chronic methotrexate therapy, and there are no data in the literature that suggest methotrexate-induced parenchymal lung disease can predispose to BPF formation. Our report is the first to introduce a probe to further investigate this association.
ISSN:2324-7096
2324-7096
DOI:10.1177/2324709619860555