Recurrent Secondary Spontaneous Pneumothorax Due to Rheumatoid Arthritis: A Report of a Rare Case

TL;DR

This paper reports a rare case of repeated lung collapses caused by rheumatoid arthritis-related lung nodules.

Contribution

The paper presents a rare clinical case linking rheumatoid arthritis to recurrent pneumothorax.

Findings

Rheumatoid arthritis can cause recurrent secondary spontaneous pneumothorax via subpleural necrobiotic nodules.

Drugs like methotrexate may accelerate the development of these nodules.

The mechanism involves rheumatoid factor and macrophage interactions leading to lung collapse.

Abstract

Secondary spontaneous pneumothorax is typically caused by tuberculosis or emphysema. Other causes include interstitial lung disease, pneumoconiosis, organizing pneumonias, and rare conditions like Langerhans cell histiocytosis and lymphangiomyomatosis. Rheumatoid arthritis is an uncommon cause of recurrent secondary spontaneous pneumothorax due to the rupture of subpleural necrobiotic nodules. Drugs like methotrexate and leflunomide are known to accelerate the development and progression of these necrobiotic nodules. Although the exact mechanism is unknown, it is believed to result from decreased monocyte activity and increased rheumatoid factor, with macrophages acting as a nidus that interacts with rheumatoid factor to form a nodule, ultimately leading to pneumothorax when it communicates with the pleural space. This report presents a rare case of recurrent spontaneous pneumothorax resulting from the rupture of subpleural necrobiotic nodules in a patient with rheumatoid arthritis-associated lung disease.

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