Rheumatoid Disease With Unusual Pulmonary Manifestations:  Pulmonary Hemosiderosis, Fibrosis, and Concretions

THE RADIOLOGICAL demonstration of a diffuse pulmonary infiltrate presents a difficult diagnostic problem to the physician initiating an extensive clinical study. Ultimately, pulmonary biopsy is required and may or may not reveal the definitive nature of the lesion. The only possible diagnosis is often "diffuse pulmonary fibrosis." In the course of evaluation of such a patient we have uncovered the unusual association of pulmonary hemosiderosis without anemia, interstitial pulmonary fibrosis, pulmonary concretions, cryoglobulinemia, and rheumatoid arthritis. Although this association of diseases may be fortuitous, a strikingly similar case was reported by Karlish in 1962.¹ The present case was studied in some detail and the results of these investigations are presented.

Report of a Case  A 42-year-old Negro man was noted to have abnormal findings on chest x-ray in 1959 in the course of a routine medical examination (Fig 1). He failed to report for further examination. In 1962 he