Fig. 14.

Aspergillosis. 57-year-old female with history of rheumatoid arthritis (RA). CT. Focal right upper lobe consolidation (arrow) represents invasive aspergillosis. Aspergillus was isolated from bronchoalveolar lavage. Peripheral subpleural reticulation and honeycombing (arrowheads) is consistent with RA-related interstitial lung disease (RA-ILD). Diffuse groundglass opacity in both lungs was thought to be due to pulmonary edema.

Teaching point: A variety of processes can be seen in RA patients, including severe RA-ILD, superimposed infection related to immunosuppression, all contributing to respiratory failure.