Bronchocentric granulomatosis in rheumatoid arthritis: case report and literature review

Bronchocentric granulomatosis (BcG) is characterized by granulomatous destruction of bronchial or bronchiolar walls and adjacent parenchyma, with debris and exudates filling the airway lumen. Approximately 50% of total cases have been associated with asthma and allergic bronchopulmonary aspergillosis, while it has been rarely reported in the context of rheumatoid arthritis (RA). We describe the case of a 69-year-old female RA patient with BcG presenting as a solitary cavitary pulmonary mass. In addition, we conducted a literature review about the clinical and imaging features of BcG in RA patients. A chronically immunosuppressed 69-year-old female patient with a 16-year history of RA presented with constitutional symptoms (low-grade fever, excessive sweating and malaise) and a sizeable cavitary lung lesion. Open lung biopsy was performed and histopathological findings were consistent with the diagnosis of BcG. Other seven cases of BcG have been previously reported in the context of RA, with clinical and laboratory characteristics described in five of them. Overall, pulmonary nodules or masses were the most frequent imaging finding of BcG, while no clear relationship with disease activity or previous treatment modalities could be established. Surgical resection followed by administration of oral steroids was effective for achieving complete remission of symptoms and radiological stability in most cases.