2022 Volume 34 Issue 4 Pages 283-289
Caplan syndrome is a combination of rheumatoid arthritis and pulmonary nodules associated with pneumoconiosis. It is rare disease, which was first described in 1953 by Dr. Anthony Caplan. We encountered a case of Caplan syndrome with multiple pulmonary nodules accelerated in the process of rheumatoid arthritis. A 71-year-old man with intellectual disability attended our hospital regularly for rheumatoid arthritis. On day X-7 he described a slight fever and worsening joint pain. It turned out that many known nodules in his lungs had gotten bigger in chest CT scans. He was admitted to our hospital on day X. We could not find specific findings in the specimens from transbronchial lung biopsy. However, in the samples obtained from CT-guided needle biopsy, palisading granulomas, circumscribed infiltrates of histiocytes perpendicularly oriented to collagen fibers of necrosis, were detected. The polarized light microscopy section revealed many silica particles. We thought these findings were consistent with rheumatoid nodules of Caplan syndrome. He had difficulty describing his medical and occupational history because of intellectual disability, therefore it was uncertain whether he had an occupational asbestos exposure. He gradually recovered by steroid treatment and left our hospital on day X+38. We confirmed the nodules had shrunk in post discharge CT scan.
