Journal List > Tuberc Respir Dis > v.70(2) > 1001587

TOOLS
Lee, Lee, Kim, Lee, Shin, Bang, Noh, Shim, Park, Lee, Park, Kim, Chang, Kim, and Kang: Caplan's Syndrome Presenting as Multiple Pulmonary Nodules
Case Report
Tuberculosis and Respiratory Diseases

Tuberculosis and Respiratory Diseases 2011; 70(2): 150-154.

Published online: 28 February 2011

DOI: https://doi.org/10.4046/trd.2011.70.2.150

Caplan's Syndrome Presenting as Multiple Pulmonary Nodules

Sang Kook Lee, M.D.1, Sang Hoon Lee, M.D.1, Song Yee Kim, M.D.1, Woo Kyung Lee, M.D.1, Dong Ho Shin, M.D.1, Woo Dae Bang, M.D.1, Song Mi Noh, M.D.2, Hyo Sup Shim, M.D.2, Byung Hoon Park, M.D.1, 3, Kyung Jong Lee, M.D.1, 3, Moo Suk Park, M.D.1, 3, Young Sam Kim, M.D.1, 3, Joon Chang, M.D.1, 3, Se Kyu Kim, M.D.1, 3, Young Ae Kang, M.D.1, 3

1Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.

2Department of Pathology, Yonsei University College of Medicine, Seoul, Korea.

3The Institute of Chest Diseases, Yonsei University College of Medicine, Seoul, Korea.

Address for correspondence: Young Ae Kang, M.D. Department of Internal Medicine, Yonsei University College of Medicine, 250, Seongsan-no, Sudaemoon-gu, Seoul 120-752, Korea. Phone: 82-2-2228-1986, Fax: 82-2-393-6884, mdkang@yuhs.ac

Received 12 June 2010       Accepted 23 July 2010

Copyright © 2011. The Korean Academy of Tuberculosis and Respiratory Diseases. All rights reserved.

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.

Keywords: Caplan Syndrome, Multiple Pulmonary Nodules, Arthritis, Rheumatoid

Figures and Tables

Figure 1
The initial chest X-ray showed multiple nodular opacities in the whole lung field.
trd-70-150-g001
Figure 2
The chest computer tomography (CT) revealed numerous well-defined tiny nodules scattered in both lungs with perilymphatic distribution.
trd-70-150-g002
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.
trd-70-150-g003
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).
trd-70-150-g004

References

1. Caplan A. Certain unusual radiological appearances in the chest of coal-miners suffering from rheumatoid arthritis. Thorax. 1953. 8:29–37.
2. Caplan A. Rheumatoid disease and pneumoconiosis (Caplan's syndrome). Proc R Soc Med. 1959. 52:1111–1113.
3. Verhaeghe A, Voisin C, Grailles M, Delcambre B, Bouscatie F. Developmental aspects of Caplan's syndrome. Rev Rhum Mal Osteoartic. 1969. 36:109–123.
4. Caplan A. Rheumatoid pneumoconiosis syndrome. Med Lav. 1965. 56:494–499.
5. Gough J, Rivers D, Seal RM. Pathological studies of modified pneumoconiosis in coal-miners with rheumatoid arthritis; Caplan's syndrome. Thorax. 1955. 10:9–18.
6. Zielonka TM, Bareła D, Zukowska M, Langfort R, Rudziński P, Chazan R. Caplan's syndrome: case report. Pol Arch Med Wewn. 2005. 114:779–784.
7. Benedek TG. Rheumatoid pneumoconiosis. Documentation of onset and pathogenic considerations. Am J Med. 1973. 55:515–524.
8. Darke C, Wagner MM, Nuki G, Dyer PA. HLA-A, B and DR antigens and properdin factor B allotypes in Caplan's syndrome. Br J Dis Chest. 1983. 77:235–242.
9. Hahon N, Morgan WK, Petersen M. Serum immunoglobulin levels in coal workers' pneumoconiosis. Ann Occup Hyg. 1980. 23:165–174.
10. Payne RB. Serum protein fractions in rheumatoid pneumoconiosis without arthritis. J Clin Pathol. 1962. 15:475–477.
11. Ondrasík M. Caplan's syndrome. Baillieres Clin Rheumatol. 1989. 3:205–210.
12. Allison AC, Harington JS, Birbeck M. An examination of the cytotoxic effects of silica on macrophages. J Exp Med. 1966. 124:141–154.
13. Pernis B. Silica and the immune system. Acta Biomed. 2005. 76:Suppl 2. 38–44.
14. Schreiber J, Koschel D, Kekow J, Waldburg N, Goette A, Merget R. Rheumatoid pneumoconiosis (Caplan's syndrome). Eur J Intern Med. 2010. 21:168–172.
15. Honma K, Vallyathan V. Rheumatoid pneumoconiosis: a comparative study of autopsy cases between Japan and North America. Ann Occup Hyg. 2002. 46:Suppl 1. 265–267.
TOOLS
Similar articles