Abstract
Caplan's syndrome: combination of pneumoconiosis and lung nodes due to seropositive rheumatoid arthritis (RA) is well known entity. We present 45 years old marble worker with fever, cough, and exertion dyspnoe with multiple lung nodes, infiltrates and fibrosis by chest CT and Raynaud syndrome with vascular finger tip lesions. Our patient had 7 years history of mixed connective tissue disease. Skin vascular lesions rapidly regressed after nifedipine therapy and methylprednisolone pulses. Substantial response of the lung disease to steroid and antibiotic therapy was not observed. Due to further respiratory failure the patient was underwent lung transplantation. Histology from removed lung showed dust laden macrophages with weak polarization positivity, advanced silicotic nodules with focal calcifications surrounded by chronic inflammation and massive fibrosis. No acid fast bacteria were found. Above mentioned findings extend a field of Caplan's syndrome. Different dusts and other rheumatic diseases, a part from RA, might be implicated.
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