Rheumatoid Lung Nodules Presenting With Hemoptysis and Cough

A 64-year-old man, smoker, was diagnosed with seropositive rheumatoid arthritis (RA) for 13 years. He was being treated with methotrexate (MTX) and hydroxychloroquine. He presented to the emergency department due to coughing and hemoptysis over the past month. Chest X-ray revealed a nodular lesion in the right lung. Chest CT scan identified several pulmonary nodules in both lungs and a right hydropneumothorax. Cultures were negative for any infectious causes. Histology of pulmonary nodules favored a diagnosis of rheumatoid lung nodules. He stopped MTX and started baricitinib.