Lung Mass in a Patient with Rheumatoid Arthritis: A Case Report




Olarte, Neal
Huynh, Minh-Duc
Miranda, Erin
Wong, Long


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Purpose: We present a case of a patient who smokes and has a past medical history of rheumatoid arthritis who presented to clinic with a chief complaint of symptomatic rheumatoid exacerbation. Given the patient's status as a smoker, we investigated whether the patient was presenting with atypical symptoms of lung cancer. Methods: We performed a physical exam on the patient and ordered appropriate labs and imaging. For the purposes of this report, we performed a literature review investigating the correlation between smoking, rheumatoid arthritis, and lung cancer. Results: The patient presented with fatigue and diffuse, symmetrical joint and bone pain. Chest x-ray and CT revealed a lingual lung mass. Smoking is a well-established risk factor for the development of lung cancer. Recent studies have shown smoking also increases the risk for the development of rheumatoid arthritis, while rheumatoid arthritis is correlated with increased risk for the development of lung cancer. Conclusions: Lung cancer typically presents with symptoms of shortness of breath and cough with or without hemoptysis, but non-specific extra-pulmonary symptoms such as fatigue may also be present. This patient presented with symptoms of acute rheumatoid exacerbation, but could also have been presenting atypically for lung cancer. Imaging confirmed the presence of a lung mass, but imaging by itself is inappropriate for making the diagnosis of lung cancer. Still, the presence of a lung mass on imaging in a patient with a history of smoking is highly suspicious for malignancy. Rheumatoid arthritis is correlated with increased incidence of lung cancer, but this correlation is small.