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Case report
Atypical presentation of rheumatoid arthritis: a case of massive bilateral pleural effusions in a patient with Caplan syndrome
  1. Yinglun Wu1 and
  2. Philip C Dittmar2
  1. 1School of Medicine, University of Maryland Baltimore, Baltimore, Maryland, USA
  2. 2Medicine, University of Maryland Baltimore, Baltimore, Maryland, USA
  1. Correspondence to Dr Philip C Dittmar; pdittmar{at}


Rheumatoid arthritis (RA) is a common connective tissue disorder affecting the synovial joints. In patients with RA, involvement of the lungs occurs in 30%–40% of cases while pleural effusions occur in only 3%–5%. However, the majority of RA-associated pleural effusions are small, unilateral and asymptomatic. We present a case of massive bilateral pleural effusions in a patient with established rheumatoid pneumoconiosis (Caplan syndrome). Interestingly, the pleural effusion occurred following recent treatment for minimal change disease and atrial fibrillation.

  • rheumatoid arthritis
  • respiratory medicine

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  • Contributors YW conceived of the presented idea. YW and PCD contributed to the design, drafting and revision of the manuscript and final approval of the version to be published. YW and PCD agree to be accountable for the manuscript and to ensure that all questions regarding the accuracy or integrity of the manuscript are investigated and resolved.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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