Progressive destructive bronchiolectasis followed by appearance of multiple pulmonary cystic lesions mimicking honeycombing in a patient with rheumatoid arthritis

Abstract

The patient was a 62-year-old man with anticitrullinated protein antibody-positive rheumatoid arthritis (RA) and a history of repeated respiratory tract infections and organizing pneumonia for eight years. Each pulmonary event required antibiotic therapy followed by adjunctive intermediate-dose corticosteroids. His RA activity had been controlled by etanercept and tacrolimus. The sequential changes in this patient’s chest CT findings illustrated the development of progressive bronchiectasis and honeycomb-like lesions over the eight years. A lung biopsy was done by video-assisted thoracic surgery. Histological examination of the specimen revealed that the multiple cystic lesions corresponding to the honeycombing on CT were mainly composed of dilated bronchioles, with abundant inflammatory cells, dense fibrous tissue and loss of elastic lamina in the walls, accompanied by vanishing alveolar structure. These findings suggest that a destructive bronchiolar inflammatory process led to the development of multiple cystic lesions mimicking honeycombing. The pathophysiology of these cystic lesions was different from that of the honeycombing associated with usual interstitial pneumonia/idiopathic pulmonary fibrosis.

Keywords:

• Rheumatoid arthritis
• bronchiolectaisis
• honeycombing
• airway disease
• usual interstitial pneumonia

Conflicts of interest

None.

Patient consent

We obtained written informed consent from our patient for publication before our submission of the current manuscript.