A case report of relapsing organizing pneumonia in rheumatoid arthritis with literature review

Rationale: Organizing pneumonia (OP) rarely occurs in patients with rheumatoid arthritis (RA). We report a case of concurrent onset of OP and RA, in which OP relapsed after 9 years, while RA remained in a state of low disease activity. Patient concerns: A 65-year-old woman presented with pain in multiple joints accompanied by recurrent fever. Chest computed tomography (CT) showed inflammation in the right lung. After treatment for the infection proved ineffective, a right lung biopsy confirmed OP. Despite 9 years of antirheumatic treatment, the patient experienced recurrent fever and cough. Chest CT revealed bilateral pneumonia. Diagnoses: The patient underwent fiberoptic bronchoscopy, and recurrence of OP was confirmed by a second lung biopsy. Interventions: Initial treatment consisted of methylprednisolone 40 mg administered once daily, followed by a gradual tapering regimen combined with iguratimod 25 mg twice daily. Outcomes: The patient’s fever and cough subsided, and chest CT showed significant improvement. The erythrocyte sedimentation rate and C-reactive protein levels were normal. Lessons: OP can occur simultaneously with RA and may recur. Lung pathology plays a crucial role in the diagnosis of these conditions.