Extract

A 34-year-old undocumented woman from Mexico, past medical history of asthma and rheumatoid arthritis (RA) presents to the ED with fever, myalgia, fatigue, cough, and difficulty taking deep breaths for the past 3 days requiring albuterol inhaler three to four times a day. Her symptoms worsened 1 h prior to arrival.

Physical examination was remarkable for bibasilar ‘velcro’ crackles with scattered expiratory wheezing in the low-middle lung fields. Chest X-ray demonstrated diffuse increased interstitial markings.

Patient was admitted for asthma exacerbation and managed with albuterol nebulizers, IV steroids and magnesium along with empiric antibiotic coverage for community acquired pneumonia.

Subsequent CT chest without contrast demonstrated a pattern of exuberant honeycombing in the periphery of the upper lungs and with more extensive honeycombing in the lung bases.

Interstitial lung disease (ILD) is the main extra-articular manifestation of RA.1 Usual interstitial pneumonia (UIP) is the most common radiologic and pathologic pattern of ILD associated with RA.2

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