An open lung biopsy case of follicular bronchiolitis in rheumatoid arthritis

A 49 year-old Japanese female with a clinical history of rheumatoid arthritis for 15 years developed fever, cough, sputa and exertional dyspnea. A chest x-ray showed right-sided pleural lesions in addition to persistent hyperinflation of the lungs for about four years. Pulmonary function tests showed combined obstructive and restrictive dysfunction, increased residual volume and reduced diffusing capacity. After an improvement of the pleural lesions, she underwent a right open lung biopsy in December 1988 which revealed follicular bronchiolitis and fibrino-fibrous pleural thickening. The pulmonary lesion of follicular bronchitis/bronchiolitis was reported in 1985 as a newly recognized pulmonary disorder among open lung biopsy cases. The present case was the second biopsy proven case of follicular bronchiolitis among the Japanese.