Journal List > J Rheum Dis > v.18(1) > 1063940

Ryu, Chang, Kim, Shin, Lee, Yim, and Song: A Case of Caplan's Syndrome Presenting as Acute Onset Polyarthritis

Abstract

Caplan originally described distinctive pulmonary nodules in miners who had suffered from rheumatoid arthritis. Later, the pulmonary nodules, together with a history of rheumatoid arthritis and exposure to inorganic dust were called Caplan's syndrome. This syndrome has been described by case reports in many countries but only two cases have been reported in Korea up to now. The patient in this case report was a 70-years-old man who had worked in the construction field for 20 years mainly de-molishing buildings. He was diagnosed with silicosis by a lung biopsy 1 year prior to admission. He suddenly developed arthralgia and morning stiffness in multiple joints 2 weeks prior to admission. Chest imaging revealed ag-gravation of the bilateral pulmonary nodules. He was diagnosed with seropositive rheumatoid arthritis. The lung nodules, arthralgia, and morning stiffness improved clinically after treatment with the corticosteroid and disease modifying antirheumatic drugs.

References

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Figure 1.
Increased size of multiple nodular opacities in both lungs (A: 1 year prior to admission, B: recent admission).
jrd-18-36f1.tif
Figure 2.
Aggravated multi-nodular opacities with right pleural effusion (A) and decreased extent of both lung lesions after steroid treatment for 6 weeks (B).
jrd-18-36f2.tif
Figure 3.
Serial changes in ESR and disease activity score (DAS)28-ESR. (A) started prednisolone (Pd), (B) added methot-rexate (MTX), hydroxychloroquine (HCQ) and sulfasalazine (SSLZ), (C) switched MTX from oral administration to subcutaneous injection, (D) discontinued SSLZ and switched to leflunomide, (E) maintained Pd, MTX, HCQ and leflunomide.
jrd-18-36f3.tif
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