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1. Bronchiectasis
All the listed disorders are associated with rheumatoid arthritis (1). There is no evidence of pleural effusion, rheumatoid nodules or pulmonary hypertension (dilated pulmonary arteries, enlarged right ventricle) on the CT scan. Rheumatoid lung fibrosis is more common in men than in women. Most commonly lung fibrosis in rheumatoid arthritis presents as usual interstitial pneumonia or nonspecific interstitial pneumonia. There is a recognized association between rheumatoid disease and obliterative bronchiolitis (constrictive bronchiolitis) in which bronchioles are destroyed and replaced by scar tissue. The characteristic CT findings are mosaic perfusion with expiratory air trapping.
The association between rheumatoid arthritis and bronchiectasis was first reported in 1955, but was considered rare until the 1990s (2). The prevalence of bronchiectasis in RA reported to range from 5.6% to 30% in prospective blinded studies with HRCT. RA is diagnosed in 2.7-5.2% of patients with bronchiectasis being seen in pulmonary clinic. The mechanism(s) underlying the association of these conditions remain unclear, but recent studies indicate an association between bronchiectasis developing in RA patients and the presence of CFTR mutations. Bronchiectasis has been found to precede RA by 16-29 years. In addition, the use of use of nonbiological and biological disease-modifying anti-rheumatic drugs likely increase the rate of lower respiratory tract infection and colonization of the airways increasing the incidence of bronchiectasis.
Our patient’s CT scan shows bronchiectasis with cylindrical bronchial dilatation and bronchial wall thickening. Her sputum culture grew Pseudomonas aeruginosa and Mycobacterium abscessus.
Which of the following is (are) true regarding nontuberculous (NTB) infection in bronchiectasis? (Click on correct answer to move to next panel)