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A 45-year-old woman had a history of rheumatoid arthritis under medical control with independent daily activity. She presented with fever (38.5°C), dry cough and dyspnoea on exertion for 5 days, accompanied with intermittent headache. Chest X-ray and CT scan both showed clear lung fields, so she was treated as upper airway infection. However, the symptoms persisted on and off for 6 months. Laboratory data on follow-up showed thrombocytopenia (54 000/µL) and lymphopenia (2.7%). A repeated chest CT scan showed fibronodular lesions and linear atelectasis (figure 1A). Empirical antibiotics failed, so interstitial lung disease or atypical infection was suspected. A wedge biopsy of the lung was performed.
Review the high quality, interactive digital Aperio slides at http://virtualacp.com/JCPCases/jclinpath-2019-205856001/ and http://virtualacp.com/JCPCases/jclinpath-2019-205856002/ and consider your diagnosis.
Handling editor Iskander Chaudhry.
Correction notice This paper has been corrected since it was published Online First. New hyperlinks to the digital slides have been added.
Contributors C-TC wrote the original version of the article; C-HW and Y-ST provided the clinical information and drafted the manuscript; K-CC revised the manuscript and supervised the whole study.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Patient consent for publication Obtained.
Provenance and peer review Commissioned; internally peer reviewed.