Dyspnea and dry cough in a patient with rheumatoid arthritis.

摘要

A 73-year-old woman presented with a three-week history of exertional dyspnea, nonproductive cough, and intermittent subjective fevers. Her medical history included rheumatoid arthritis with stable pleuropulmonary involvement, which was treated initially with corticosteroids. Eight months before presentation, the patient started taking methotrex-ate in addition to the corticosteroid regimen because of poor clinical response to and side effects from the original treatment. Metho-trexate therapy improved joint symptoms and allowed for tapering of the steroids. The patient also had a history of breast cancer that was treated with curative mastectomy 17 years earlier; no radiation or chemotherapy had been used. She denied tobacco use or occupational pulmonary risk factors.