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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.
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