Caplan syndrome — SCE Rheumatology MCQ

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EasyRheumatoid arthritisCaplan syndromeSCE Rheumatology

A 58-year-old former coal miner with established seropositive rheumatoid arthritis is reviewed because of a persistent cough. Chest radiography shows multiple well-defined, rounded nodules, predominantly at the lung periphery. What is the most likely diagnosis?

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Correct answer: A — Caplan syndrome

The correct answer is Caplan syndrome (rheumatoid pneumoconiosis). Its characteristic setting is rheumatoid arthritis in a person exposed to inhaled inorganic dust, classically a coal miner, with multiple well-defined rounded pulmonary nodules that are often peripheral and may cavitate or calcify. Rheumatoid pleuritis causes pleural thickening or an exudative effusion rather than multiple parenchymal nodules. Granulomatosis with polyangiitis can produce cavitating nodules, but supporting upper-airway, renal or other vasculitic features are absent. Tuberculosis remains an important clinical exclusion, particularly with constitutional symptoms or cavitation, but does not explain this classic occupational–rheumatological combination. Sarcoidosis more typically causes bilateral hilar lymphadenopathy and perilymphatic micronodules. Atypical or changing nodules still require assessment for infection and malignancy.

Reference: Schreiber J, Koschel D, Kekow J, et al. Rheumatoid pneumoconiosis (Caplan's syndrome). European Journal of Internal Medicine. 2010;21(3):168-172. https://pubmed.ncbi.nlm.nih.gov/20493416/