Rheumatoid lung sine arthritis – An unusual case mimicking idiopathic pulmonary fibrosis

Abstract

We present the case of a 72-year-old male, with no history of connective tissue disease or musculoskeletal symptoms, who presented to our pulmonary clinic with five years of worsening dyspnea and presyncope with exertion. Pertinent findings on evaluation were computerized tomography of the chest showing diffuse honeycombing, pulmonary function tests demonstrating an intrinsic restrictive ventilatory defect, labs significant for an elevated C-reactive protein and erythrocyte sedimentation rate, and serologies remarkable for positive rheumatoid factor, positive anti-cyclic citrullinated peptide antibodies, and positive anti-nuclear antibody. Despite never having articular or other systemic manifestations of rheumatoid arthritis (RA), the patient was diagnosed with rheumatoid lung disease, started on definitive therapy and referred to rheumatology. An awareness of this unusual presentation of connective tissue related lung disease is critical to prevent misdiagnosis as idiopathic pulmonary fibrosis, so proper management and optimal patient outcomes are ensured.