Follicular bronchiolitis preceding rheumatoid arthritis]

A 52-year-old woman visited our hospital because of a cough and stridor in 1994. She had a history of non-tuberculous mycobacteriosis and chronic paranasal sinusitis. Her chest CT scan showed scattered centrilobular nodular shadows and peribronchial thickening, and so we suspected recurrent non-tuberculous mycobacteriosis or diffuse panbronchiolitis. Clarithromycin treatment was initiated, but she soon ceased taking the drug. She visited our hospital again because of a severe cough three and half years later. A new chest CT scan showed increased abnormal shadows, and so we suspected worsening non-tuberculous mycobacteriosis or diffuse panbronchiolitis. Consequently, we commenced treatment with rifampicin, ethambutol hydrochloride as well as clarithromycin. One year later, rheumatoid arthritis was diagnosed because of a swollen proximal interphalangeal joint in both fourth fingers. Her respiratory symptoms were not relieved with clarithromycin or antituberculous drugs, so a thoracoscopic biopsy was performed for a more accurate diagnosis. Histological examination revealed follicular bronchiolitis.