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A 61-year-old woman was under treatment with a combination of methotrexate and leflunomide for seropositive rheumatoid arthritis (RA) for the past 6 years. She presented to us 6 months earlier with grade 1 dyspnoea of 3-month duration. She was a non-smoker. On evaluation, her vitals, and respiratory and cardiovascular system were normal. Laboratory reports revealed normal blood count, and renal and liver function tests were also normal. Chest X-ray revealed multiple nodules (in left upper lobe and right lower lobe). CT of the chest confirmed bilateral multiple necrotic and non-necrotic nodules (figures 1 and 2). Since the differential diagnoses included …
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