Unusual findings were noted in a case of nodular rheumatoid pulmonary disease with roentgenographic evidence of cavitation. Biopsy specimen of the cavitated nodule was identical microscopically to the patient's typical subcutaneous rheumatoid nodule. Of further interest was the associated pleural effusion with low glucose concentration, high total lipid content, and extremely high lactic acid dehydrogenase level. To the best of the author's knowledge, chronic lipid effusion and elevated lactic acid dehydrogenase have not been previously reported in association with rheumatoid disease of the lung. The diagnostician must consider rheumatoid disease in the differential diagnosis of cavitary pulmonary lesions in the patient with associated rheumatoid disease. Adequate biopsy and microscopic confirmation of the process are still required for definite diagnosis.
Stengel BF, Watson RR, Darling RJ. Pulmonary Rheumatoid Nodule With Cavitation and Chronic Lipid Effusion. JAMA. 1966;198(12):1263-1266. doi:10.1001/jama.1966.03110250077022