SHM Converge Scientific Abstract ePoster Gallery-Rheumatoid Arthritis-Associated Interstitial Lung Disease (Ra-Ild) Presenting as Organizing Pneumonia With Productive Cough

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This case report describes a 50-year-old woman with rheumatoid arthritis (RA) who was hospitalized for fever, shortness of breath, chest heaviness, productive cough, and significant weight loss. She was initially treated for multifocal pneumonia with broad-spectrum antibiotics, but her condition continued to worsen despite repeatedly negative bacterial, viral, and fungal cultures. Her history of RA, recent discontinuation of methotrexate and rituximab, and persistent pulmonary symptoms raised concern for connective tissue disease-associated interstitial lung disease (CTD-ILD), specifically RA-associated ILD (RA-ILD).<br /><br />Repeat chest CT scans showed migratory, waxing and waning central and subpleural ground-glass opacities and infiltrates, findings more consistent with an inflammatory interstitial process than infection. Bronchoscopy and lung biopsy eventually revealed patchy fibrinous organizing pneumonia with nonspecific interstitial thickening and type II pneumocyte hyperplasia. Infectious stains were negative, supporting a noninfectious diagnosis. The patient improved after corticosteroids were started and was discharged on high-dose oral prednisone with rheumatology follow-up after a prolonged 48-day hospital stay.<br /><br />The report highlights that RA-ILD can present atypically, including with productive cough and fever, and may mimic pneumonia. Organizing pneumonia is one of the RA-ILD subtypes most likely to respond to glucocorticoids, making early recognition important. The authors emphasize that clinicians should include CTD-ILD in the differential diagnosis for patients with autoimmune disease and unexplained pulmonary symptoms, especially when antibiotics fail and cultures remain negative. Prompt diagnosis and treatment may improve outcomes and reduce hospital length of stay.

Asset Subtitle

Michael Shearer

Meta Tag

Author List Mahmuda Begum, Michael Shearer, Shyam S. Ramachandran

Category Clinical Vignettes

Concept Rheumatoid Arthritis-Associated Interstitial Lung Disease

Concept Interstitial Lung Disease

Concept Rheumatoid Arthritis

Concept Pneumonia

Concept Secondary Organizing Pneumonia

Distinguished Non-Finalist

Presenter Organization Texas A&M University College of Medicine

Presenting Author Michael Shearer

Track Adult

Keywords

rheumatoid arthritis

RA-ILD

connective tissue disease-associated interstitial lung disease

organizing pneumonia

ground-glass opacities

bronchoscopy

lung biopsy

corticosteroids

pneumonia mimic

autoimmune disease

Rheumatoid Arthritis-Associated Interstitial Lung Disease

Interstitial Lung Disease

Rheumatoid Arthritis

Pneumonia

Secondary Organizing Pneumonia