Monday, March 3, 2008

Boards Prep

A 70 year old European coal miner comes to you with joint pain and trouble breathing. You notice his hands:

On CXR, you find multiple peripheral basilar nodules. He is PPD and HIV negative. You rule out the most common etiology of multiple pulmonary nodules (which you learned for Boards): metastatic solid organ malignancy, Non-Hodgkin's lymphoma, Kaposi sarcoma, multiple bacterial abscesses, septic emboli, fungi (histoplasmosis, coccidioidomycosis, aspergillosis, cryptococcus), flukes (Paragnomius westermani), Wegener's granulomatosis, and AV malformation. Histology of one of those nodules would show the following:

Interesting. You note the central necrosis. This is an odd association between two diseases, one reflecting the joint pain and one reflecting the pulmonary nodules.

Challenge: What is this syndrome called?

Both images shown under fair use.
Case idea and title contributed by Alex Penn.


tree said...

Caplan's syndrome

Craig said...

Boards Prep

This is Caplan’s syndrome (hence the title of the case), found in patients with rheumatoid arthritis and pneumoconiosis related to mining dust (coal, asbestos, silica) exposure. There is rapid development of multiple pulmonary rheumatoid nodules; histology shows central necrosis, surrounding pigment cells, palisading epithelioid cells, mononuclear cell infiltrate, and vasculitis.

Sources: Alex Penn, UpToDate, bio.davidson,edu,