Case 10-2001

Presentation of CaseA 53-year-old woman was admitted to the hospital because of radiographically evident pulmonary nodules.The patient had a long history of seropositive rheumatoid arthritis, which was usually well controlled with naproxen. Six years before admission, a painful lump in the right Achilles tendon was excised; microscopical examination indicated that the mass was a rheumatoid nodule. When the patient was seen at this hospital three and a half years before admission, she was using an albuterol inhaler because of a cough productive of clear sputum. Bronchoconstriction was later diagnosed, and bronchodilator therapy was continued.At a subsequent visit, . . .