CTICasesRheumatoid Lung Nodule
Imaging findings
Chest CT in a patient with rheumatoid arthritis treated with etanercept (Enbrel) shows a large, solid, right lower lobe nodule. A prior CT scan had shown a cavitary left lower lobe lesion in the same location that was biopsy-proven to represent an Aspergillus infection. CT-guided biopsy of the new right lower lobe nodule, however, confirms a rheumatoid necrobiotic nodule, with no evidence of fungal elements.
Key takeaways
Rheumatoid nodules are a classic extra-articular manifestation of rheumatoid arthritis. They typically present as multiple subpleural or parenchymal nodules that frequently cavitate. In immunocompromised patients (such as those on TNF-alpha blockers), these nodules can look identical to opportunistic fungal infections like aspergillosis, and serial biopsies may be necessary to differentiate active infection from rheumatoid disease.
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